Healthcare Provider Details

I. General information

NPI: 1801500236
Provider Name (Legal Business Name): FAITH FAMILY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 STAFFORD DR
PRINCETON WV
24740-2409
US

IV. Provider business mailing address

617 MERCER ST
PRINCETON WV
24740-3111
US

V. Phone/Fax

Practice location:
  • Phone: 304-887-3530
  • Fax:
Mailing address:
  • Phone: 304-425-2405
  • Fax: 304-425-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY SUE CURRY
Title or Position: MEMBER/ADMIN
Credential: FNP
Phone: 304-887-3530