Healthcare Provider Details

I. General information

NPI: 1255293064
Provider Name (Legal Business Name): FAITH MENTAL HEALTH SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 STAFFORD AVE
RAEFORD NC
28376-9295
US

IV. Provider business mailing address

257 STAFFORD AVE
RAEFORD NC
28376-9295
US

V. Phone/Fax

Practice location:
  • Phone: 910-489-0249
  • Fax:
Mailing address:
  • Phone: 910-489-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNDORA DAY
Title or Position: OWN
Credential:
Phone: 910-489-0249