Healthcare Provider Details

I. General information

NPI: 1538399381
Provider Name (Legal Business Name): FAITH HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WALLINGTON RD
WILMINGTON NC
28409-8542
US

IV. Provider business mailing address

210 WALLINGTON RD
WILMINGTON NC
28409-8542
US

V. Phone/Fax

Practice location:
  • Phone: 910-399-2602
  • Fax:
Mailing address:
  • Phone: 910-399-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MISS SHAREMA LATRESE WILLIAMS
Title or Position: PRESIDENT
Credential: MHA/ED
Phone: 910-297-0787