Healthcare Provider Details

I. General information

NPI: 1487574695
Provider Name (Legal Business Name): HIS FAITH DRIVERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MINER DR APT C3
MEDINA OH
44256-1438
US

IV. Provider business mailing address

PO BOX 121
MEDINA OH
44258-0121
US

V. Phone/Fax

Practice location:
  • Phone: 330-289-5469
  • Fax: 330-331-4138
Mailing address:
  • Phone: 330-289-5469
  • Fax: 330-331-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARLA A MCKISSACK
Title or Position: CEO
Credential:
Phone: 330-289-5469