Healthcare Provider Details

I. General information

NPI: 1215690862
Provider Name (Legal Business Name): CHRISTIAN FAITH HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 RAEFORD RD STE A1
FAYETTEVILLE NC
28304-3203
US

IV. Provider business mailing address

PO BOX 53281
FAYETTEVILLE NC
28305-3281
US

V. Phone/Fax

Practice location:
  • Phone: 910-777-9402
  • Fax: 910-809-2327
Mailing address:
  • Phone: 910-777-9402
  • Fax: 910-809-2327

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: SHAZADA KEITH
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 910-777-9402