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General NPI Number Information
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NPI Number | 1205539459
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Entity Type | Organization
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Legal Business Name | FAITHWORX COMPANION HOME CARE LLC.
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 12733 W HOLLY ST
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City | AVONDALE
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State | AZ
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Zip | 85392-6416
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Country | US
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Telephone | 480-375-1644
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Fax |
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Provider Business Mailing Address
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Address Line | 12733 W HOLLY ST
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City | AVONDALE
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State | AZ
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Zip | 85392-6416
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DAMIAN HUDSON
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Credential |
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Telephone | 480-375-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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