Healthcare Provider Details

I. General information

NPI: 1780127589
Provider Name (Legal Business Name): FAITH CHRISTIAN MINISTRY NON-DENOMINATIONAL CHURCH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 BEAUFONT SPRINGS DRIVE SUITE 300
RICHMOND VA
23225
US

IV. Provider business mailing address

7306 SUMMERTREE DR
NORTH CHESTERFIELD VA
23234-5935
US

V. Phone/Fax

Practice location:
  • Phone: 866-720-5321
  • Fax:
Mailing address:
  • Phone: 866-720-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number14946
License Number StateVA

VIII. Authorized Official

Name: DR. MONA JUANITA PETERSON-OMOTOLA
Title or Position: PASTOR/PASTORAL COUNSELOR
Credential: REV. DR. PH.D.
Phone: 866-720-5321