MEDICARE: FAITH HOME HEALTH 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1992320808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HOME HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	6370 LA PUENTE DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1127
Country	:	US
Telephone Number	:	832-249-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	6370 LA PUENTE DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1127
Country	:	US
Telephone Number	:	832-249-0904
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. RONKE FAKIYESI
Credential	:
Telephone Number	:	832-249-0904

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/16/2020

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