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General NPI Number Information
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NPI Number | 1780981316
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Entity Type | Organization
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Legal Business Name | FAITHWAY TRANSPORTATION
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 621 N 5TH ST
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City | NASHVILLE
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State | TN
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Zip | 37207-5812
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Country | US
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Telephone | 313-682-7186
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Fax | 734-981-1374
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Provider Business Mailing Address
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Address Line | 1195 LAWRENCE ST
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City | DETROIT
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State | MI
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Zip | 48202-1028
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Country | US
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Telephone | 313-682-7186
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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. MOSES LEVELLE BOONE II
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Credential |
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Telephone | 313-682-7186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 01413L
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License Number State | MI
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