MEDICARE: FAITH MENTAL HEALTH SERVICE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	385HR2055X	Child Mental Illness Respite Care
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	385HR2065X	Child Physical Disabilities Respite Care
4	385H00000X	Respite Care

General Provider Information

NPI Number	:	1255293064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH MENTAL HEALTH SERVICE LLC

Provider Business Mailing Address
First Line	:	257 STAFFORD AVE
Second Line	:
City	:	RAEFORD
State	:	NC
Zip	:	28376-9295
Country	:	US
Telephone Number	:	910-489-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	257 STAFFORD AVE
Second Line	:
City	:	RAEFORD
State	:	NC
Zip	:	28376-9295
Country	:	US
Telephone Number	:	910-489-0249
Fax Number	:

Authorized Official
Title or Position	:	OWN
Name	:	MS. LYNDORA DAY
Credential	:
Telephone Number	:	910-489-0249

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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