MEDICARE: FAITH FAMILY PRACTICE AND WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1114764578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH FAMILY PRACTICE AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	1335 MEADOWCREEK LN
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-4615
Country	:	US
Telephone Number	:	717-610-6907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 MEADOWCREEK LN
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-4615
Country	:	US
Telephone Number	:	717-610-6907
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WILLY KARANJA
Credential	:
Telephone Number	:	717-610-6907

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	06/09/2026

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