=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861828394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOUCHED BY FAITH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2013
-----------------------------------------------------
Last Update Date | 09/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 351 15TH ST N
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33705-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-289-1916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 35465
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33705-0508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-289-1916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARCUS ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-380-9843
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | AL11520
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------