=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962837955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEN FAITH HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2013
-----------------------------------------------------
Last Update Date | 09/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3222 THIRTEEN COLONY MALL SUITE 4
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-864-8551
-----------------------------------------------------
Fax | 901-791-4427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3222 THIRTEEN COLONY MALL SUITE 4
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-864-8551
-----------------------------------------------------
Fax | 901-791-4427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHARON DIANE WEBBER
-----------------------------------------------------
Credential | 07/10/1965
-----------------------------------------------------
Telephone | 901-864-8551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 113003017
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------