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General NPI Number Information
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NPI Number | 1063729499
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Entity Type | Organization
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Legal Business Name | FAITH FARM, INC
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 21 STRETCH RD
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City | BRIDGETON
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State | NJ
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Zip | 08302-9260
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Country | US
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Telephone | 856-455-6145
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Fax | 856-453-0093
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Provider Business Mailing Address
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Address Line | 21 STRETCH RD
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City | BRIDGETON
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State | NJ
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Zip | 08302-9260
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Country | US
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Telephone | 856-455-6145
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Fax | 856-453-0093
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SONITA JOHNSON
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Credential |
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Telephone | 856-455-6145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1000064-10
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License Number State | NJ
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