Healthcare Provider Details

I. General information

NPI: 1912641473
Provider Name (Legal Business Name): FAITH ENTRUSTED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 SMOKEY QUARTZ LN
ARLINGTON TX
76005-1346
US

IV. Provider business mailing address

4723 SMOKEY QUARTZ LN
ARLINGTON TX
76005-1346
US

V. Phone/Fax

Practice location:
  • Phone: 817-487-7378
  • Fax: 817-549-7327
Mailing address:
  • Phone: 817-487-7378
  • Fax: 817-549-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAVONDA FICKLIN
Title or Position: OWNER
Credential: RN
Phone: 817-487-7378