Provider Demographics
NPI:1306314679
Name:ARM FAITHFUL HOME LLC
Entity type:Organization
Organization Name:ARM FAITHFUL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-466-8793
Mailing Address - Street 1:18909 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-2122
Mailing Address - Country:US
Mailing Address - Phone:571-466-8793
Mailing Address - Fax:888-752-5586
Practice Address - Street 1:18909 RED OAK LN
Practice Address - Street 2:
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-2122
Practice Address - Country:US
Practice Address - Phone:571-466-8793
Practice Address - Fax:888-752-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACISECOMMedicaid