Healthcare Provider Details

I. General information

NPI: 1790918977
Provider Name (Legal Business Name): FAITH WORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N STATE ST.
STANTON MI
48888
US

IV. Provider business mailing address

P.O. BOX 160 806 N. STATE ST.
STANTON MI
48888
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-9960
  • Fax: 989-831-8770
Mailing address:
  • Phone: 989-831-9960
  • Fax: 989-831-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. SUZANNE ARLENE RASMUSSEN
Title or Position: OWNER
Credential:
Phone: 989-831-9960