MEDICARE: FAITHWORKS COMMUNITY SERVICES INC.

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1992199863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITHWORKS COMMUNITY SERVICES INC.

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD # 2374
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	702-409-3798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1478 E RENO AVE APT 18A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-1692
Country	:	US
Telephone Number	:	702-409-3798
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SOPHIA MCGEE
Credential	:
Telephone Number	:	702-409-3798

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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