Provider Demographics
NPI:1104818723
Name:FAITH COMMUNITY HOSPITAL HOME HEALTH
Entity type:Organization
Organization Name:FAITH COMMUNITY HOSPITAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-567-6633
Mailing Address - Street 1:717 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76458-1111
Mailing Address - Country:US
Mailing Address - Phone:940-567-6633
Mailing Address - Fax:940-567-5714
Practice Address - Street 1:717 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-1111
Practice Address - Country:US
Practice Address - Phone:940-567-6633
Practice Address - Fax:940-567-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677249Medicare ID - Type UnspecifiedMEDICARE PROVIDER #