MEDICARE: FAITH PARTNERS CARE GROUP

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	49201	VA

General Provider Information

NPI Number	:	1124087010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH PARTNERS CARE GROUP

Provider Business Mailing Address
First Line	:	3105 W MARSHALL ST
Second Line	:	STE 205
City	:	RICHMOND
State	:	VA
Zip	:	23230-4722
Country	:	US
Telephone Number	:	804-329-1681
Fax Number	:	804-329-1684

Provider Business Practice Location Address
First Line	:	3708 BIRDWOOD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234
Country	:	US
Telephone Number	:	804-275-9256
Fax Number	:	804-275-9257

Authorized Official
Title or Position	:	CEO
Name	:	JOHN THOMAS REDD
Credential	:
Telephone Number	:	804-543-8332

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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