MEDICARE: FAITHFUL FRIENDS OF NORTH PORT, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1811655269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITHFUL FRIENDS OF NORTH PORT, LLC

Provider Business Mailing Address
First Line	:	3727 WENONA DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-1437
Country	:	US
Telephone Number	:	941-237-8174
Fax Number	:	941-242-5028

Provider Business Practice Location Address
First Line	:	3727 WENONA DR
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-1437
Country	:	US
Telephone Number	:	941-237-8174
Fax Number	:	941-242-5028

Authorized Official
Title or Position	:	OWNER
Name	:	RUTHE GUILLAURY
Credential	:
Telephone Number	:	941-237-8174

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	12/02/2021

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