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General NPI Number Information
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NPI Number | 1760897771
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Entity Type | Organization
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Legal Business Name | WALK BY FAITH ADULT HEALTH & DAY CARE LLC
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 1004 W BROAD ST
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City | DUNN
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State | NC
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Zip | 28334-4708
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Country | US
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Telephone | 910-891-2770
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Fax | 910-891-2771
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Provider Business Mailing Address
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Address Line | 1004 W BROAD ST
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City | DUNN
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State | NC
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Zip | 28334-4708
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Country | US
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Telephone | 910-891-2770
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Fax | 910-891-2771
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Authorized Official
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Title or Position | OWNER/HEALTH CARE COORDINATOR
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Name | DEANGELO JACKSON
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Credential |
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Telephone | 910-891-2770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | PE KX5D1Z7TA
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | PE-KX5D1Z7TA
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | PE-KX5D1Z7TA
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | PE-KX5D1Z7TA
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License Number State | NC
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