Provider Demographics
NPI:1588422141
Name:FAITH FREEDOM HEALTH LLC
Entity type:Organization
Organization Name:FAITH FREEDOM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:304-634-2772
Mailing Address - Street 1:347 COUNTY ROAD 411
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-9404
Mailing Address - Country:US
Mailing Address - Phone:740-451-0511
Mailing Address - Fax:740-451-0605
Practice Address - Street 1:347 COUNTY ROAD 411
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-9404
Practice Address - Country:US
Practice Address - Phone:740-451-0511
Practice Address - Fax:740-451-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty