=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215794953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITH COMMUNITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2024
-----------------------------------------------------
Last Update Date | 02/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 N COURTHOUSE RD, SUITE 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-903-3460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12750 ROUTE 1 # 329
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23831-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-903-3460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-QDDP
-----------------------------------------------------
Name | STEFANIE FLEMING
-----------------------------------------------------
Credential | QDDP
-----------------------------------------------------
Telephone | 252-903-3460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------