Healthcare Provider Details

I. General information

NPI: 1639521875
Provider Name (Legal Business Name): DHC FAITH HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16217 N MAY AVE
EDMOND OK
73013-8871
US

IV. Provider business mailing address

468 HALLE PARK DR
COLLIERVILLE TN
38017-7089
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-1700
  • Fax:
Mailing address:
  • Phone: 901-692-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WAYNE ADDISON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 901-692-5555