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General NPI Number Information
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NPI Number | 1689979932
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Entity Type | Organization
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Legal Business Name | THE FAITH FOUNDATION
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 1112 TAYLOR
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City | VA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-923-0959
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Fax |
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Provider Business Mailing Address
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Address Line | 309 FESTIVAL CT
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City | SUFFOLK
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State | VA
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Zip | 23434-9255
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Country | US
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Telephone | 757-923-0959
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. NATHANIEL JACKSON III
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Credential |
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Telephone | 757-923-0959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1349
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License Number State | VA
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