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General NPI Number Information
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NPI Number | 1841448669
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Entity Type | Organization
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Legal Business Name | FAITHWORKS ASSISTED LIVING
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 814 LINDSEY ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-3112
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Country | US
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Telephone | 336-394-4216
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Fax |
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Provider Business Mailing Address
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Address Line | 210 S VAN BUREN RD
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City | EDEN
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State | NC
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Zip | 27288-5025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ZACK TURNER MARTIN JR.
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Credential |
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Telephone | 336-394-4216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-079-067
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License Number State | NC
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