MEDICARE: FAITH HOME CARE AGENCY 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	311500000X	Alzheimer Center (Dementia Center)
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1154877975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	4003 LAKE BRAZOS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-8092
Country	:	US
Telephone Number	:	281-750-0900
Fax Number	:	281-750-0901

Provider Business Practice Location Address
First Line	:	4003 LAKE BRAZOS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-8092
Country	:	US
Telephone Number	:	281-750-0900
Fax Number	:	281-750-0901

Authorized Official
Title or Position	:	MANAGER
Name	:	DEBO JOKODOLA
Credential	:
Telephone Number	:	281-750-0900

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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