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General NPI Number Information
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NPI Number | 1386044337
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Entity Type | Organization
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Legal Business Name | HAVE FAITH SUPPORT SERVICES
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 112 LANE AVE S # 5
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City | JACKSONVILLE
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State | FL
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Zip | 32254-3524
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Country | US
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Telephone | 904-382-9826
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Fax |
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Provider Business Mailing Address
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Address Line | 2276 CHEROKEE COVE TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32221-4906
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Country | US
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Telephone | 904-382-9826
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARINESA POKE
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Credential |
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Telephone | 904-482-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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