Healthcare Provider Details

I. General information

NPI: 1043830359
Provider Name (Legal Business Name): FAITHFUL BEGINNINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24486 BASHIAN DR
NOVI MI
48375-2924
US

IV. Provider business mailing address

24486 BASHIAN DR
NOVI MI
48375-2924
US

V. Phone/Fax

Practice location:
  • Phone: 313-926-7813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JULIANNA IVORY
Title or Position: OWNER
Credential:
Phone: 313-926-7813