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General NPI Number Information
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NPI Number | 1063871309
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Entity Type | Organization
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Legal Business Name | CHILDLIKE FAITH SERVICES, LLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 12417 BRANNER WAY 103
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City | CHESTER
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State | VA
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Zip | 23836-2807
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Country | US
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Telephone | 804-475-2441
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3464
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City | CHESTER
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State | VA
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Zip | 23831-8464
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Country | US
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Telephone | 804-475-2441
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RAYMOND LEE HOWARD JR.
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Credential |
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Telephone | 804-475-2441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | S4477073
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License Number State | VA
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