Provider Demographics
NPI:1194050856
Name:FAITHFUL SERVANT IN HOME CARE
Entity type:Organization
Organization Name:FAITHFUL SERVANT IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JERMILLS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-712-1792
Mailing Address - Street 1:5505 KEYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4466
Mailing Address - Country:US
Mailing Address - Phone:704-535-2297
Mailing Address - Fax:704-535-2298
Practice Address - Street 1:5505 KEYWAY BLVD APT J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5747
Practice Address - Country:US
Practice Address - Phone:704-535-2297
Practice Address - Fax:704-535-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services