Healthcare Provider Details

I. General information

NPI: 1326966680
Provider Name (Legal Business Name): FAITH BRIDGE CARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SOUTHERN OAK WAY
CANTON MS
39046-1119
US

IV. Provider business mailing address

272 CALHOUN STATION PKWY STE C
GLUCKSTADT MS
39110-5541
US

V. Phone/Fax

Practice location:
  • Phone: 769-972-2877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TEAWONA HENDERSON
Title or Position: OWNER
Credential:
Phone: 769-972-2877