Provider Demographics
NPI:1457979452
Name:FAITH HEALTH SERVICES
Entity type:Organization
Organization Name:FAITH HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLOSSOM
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-917-4346
Mailing Address - Street 1:879 CARRIAGE RUN CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-2414
Mailing Address - Country:US
Mailing Address - Phone:404-917-4346
Mailing Address - Fax:
Practice Address - Street 1:2100 18TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3668
Practice Address - Country:US
Practice Address - Phone:404-917-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health