Healthcare Provider Details

I. General information

NPI: 1831035252
Provider Name (Legal Business Name): FAITH MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 EISENHOWER AVE STE 140
ALEXANDRIA VA
22314-5378
US

IV. Provider business mailing address

2034 EISENHOWER AVE STE 140
ALEXANDRIA VA
22314-5378
US

V. Phone/Fax

Practice location:
  • Phone: 227-259-4116
  • Fax:
Mailing address:
  • Phone: 227-259-4116
  • Fax:

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: ICHOIKOH WANUKI ACHANGOH
Title or Position: OWNER
Credential:
Phone: 227-259-4116