Healthcare Provider Details

I. General information

NPI: 1477329415
Provider Name (Legal Business Name): FAITH HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14098 US HIGHWAY 27 S
WAYNESBURG KY
40489-8253
US

IV. Provider business mailing address

521 CRANE RD
SOMERSET KY
42501-9503
US

V. Phone/Fax

Practice location:
  • Phone: 606-379-6646
  • Fax:
Mailing address:
  • Phone: 66-425-5768
  • Fax: 606-425-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TABATHA NICOLE FLYNN
Title or Position: SENIOR PROJECT DIRECTOR
Credential:
Phone: 606-425-5768