Provider Demographics
NPI:1528513801
Name:FRUIT OF THE SPIRIT HOME HEALTH CARE
Entity type:Organization
Organization Name:FRUIT OF THE SPIRIT HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-623-3161
Mailing Address - Street 1:5211 JONES RD N
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-2113
Mailing Address - Country:US
Mailing Address - Phone:251-623-3161
Mailing Address - Fax:251-644-7601
Practice Address - Street 1:5211 JONES RD N
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-2113
Practice Address - Country:US
Practice Address - Phone:251-623-3161
Practice Address - Fax:251-644-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health