MEDICARE: FAITHFUL CARE SERVICES, 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1174896526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITHFUL CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1762 DALLAS DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1438
Country	:	US
Telephone Number	:	225-288-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 DALLAS DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1438
Country	:	US
Telephone Number	:	225-288-7555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHLEEN WILSON
Credential	:
Telephone Number	:	225-288-7555

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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