Healthcare Provider Details

I. General information

NPI: 1669707618
Provider Name (Legal Business Name): MY FAITH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 MOUNT MORIAH RD SUITE B415
MEMPHIS TN
38115-1511
US

IV. Provider business mailing address

3393 CLARKE RD
MEMPHIS TN
38115-3522
US

V. Phone/Fax

Practice location:
  • Phone: 901-238-4071
  • Fax: 901-791-2572
Mailing address:
  • Phone: 901-238-4071
  • Fax: 901-791-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL000000004203
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. BARBARA JOHNSON-MCKINNEY
Title or Position: CEO
Credential: LCSW
Phone: 901-831-1231