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General NPI Number Information
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NPI Number | 1205508314
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Entity Type | Organization
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Legal Business Name | FAITH INDEPENDENCE 3A INC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 456 CANBY CIR
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City | OCOEE
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State | FL
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Zip | 34761-8903
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Country | US
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Telephone | 407-309-0481
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Fax | 407-641-9799
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Provider Business Mailing Address
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Address Line | 456 CANBY CIR
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City | OCOEE
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State | FL
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Zip | 34761-8903
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Country | US
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Telephone | 407-309-0481
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Fax | 407-641-9799
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Authorized Official
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Title or Position | OWNER
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Name | LUE JIMMIE FILLICIA JOHNSON
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Credential |
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Telephone | 407-309-0481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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