=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841222585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITH HOME CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 03/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2530-H EAST 71ST STREET
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-621-4454
-----------------------------------------------------
Fax | 918-622-9117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2524 A-EAST 71ST STREET
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-621-4454
-----------------------------------------------------
Fax | 918-622-9117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | KRYSTAL SHEPHARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-623-0955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7821
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------