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General NPI Number Information
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NPI Number | 1972962330
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Entity Type | Organization
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Legal Business Name | FAITHFUL FOUNDATION LLC
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Dates
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Enumeration Date | 02/14/2016
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Last Update Date | 02/14/2016
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Provider Practice Location Address
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Address Line | 2116 NE 111TH TER
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City | KANSAS CITY
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State | MO
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Zip | 64155-8537
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Country | US
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Telephone | 816-222-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 NE 111TH TER
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City | KANSAS CITY
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State | MO
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Zip | 64155-8537
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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/MANAGER
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Name | MRS. DENISE LOWE
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Credential | MS
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Telephone | 816-222-4783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LC001475210
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License Number State | MO
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