=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790918977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITH WORKS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2009
-----------------------------------------------------
Last Update Date | 09/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 N STATE ST.
-----------------------------------------------------
City | STANTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-831-9960
-----------------------------------------------------
Fax | 989-831-8770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 160 806 N. STATE ST.
-----------------------------------------------------
City | STANTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-831-9960
-----------------------------------------------------
Fax | 989-831-8770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SUZANNE ARLENE RASMUSSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-831-9960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------