Healthcare Provider Details

I. General information

NPI: 1780429191
Provider Name (Legal Business Name): FACES OF ILLUSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 CONGAREE RD SUIT 17
GREENVILLE SC
29607
US

IV. Provider business mailing address

500 MABRY PLACE
GRAYSON GA
30017
US

V. Phone/Fax

Practice location:
  • Phone: 864-914-6506
  • Fax: 864-561-9911
Mailing address:
  • Phone: 678-502-6987
  • 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: ROBERT CHRISTOPHER WHITE
Title or Position: OWNER/MANAGER
Credential:
Phone: 678-502-6987