Provider Demographics
NPI:1902622434
Name:FAITH MINISTRY TRINITY LIFE FAMILY INC
Entity type:Organization
Organization Name:FAITH MINISTRY TRINITY LIFE FAMILY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:REESE GREY-BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, SP, PCC, CNA,
Authorized Official - Phone:205-718-1181
Mailing Address - Street 1:1297 MIXON SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-6194
Mailing Address - Country:US
Mailing Address - Phone:205-718-1181
Mailing Address - Fax:
Practice Address - Street 1:1297 MIXON SCHOOL RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-6194
Practice Address - Country:US
Practice Address - Phone:205-718-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVING CARE OF ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-30
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty