Provider Demographics
NPI:1528760170
Name:FAITH RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:FAITH RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHIRWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-770-6393
Mailing Address - Street 1:900 SE PARK ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2263
Mailing Address - Country:US
Mailing Address - Phone:515-770-6393
Mailing Address - Fax:
Practice Address - Street 1:900 SE PARK ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2263
Practice Address - Country:US
Practice Address - Phone:515-770-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities