Provider Demographics
NPI:1962282368
Name:FAITH PCA SERVICES LLC
Entity type:Organization
Organization Name:FAITH PCA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-708-9431
Mailing Address - Street 1:5636 E JUDGE PEREZ DR STE F
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-2946
Mailing Address - Country:US
Mailing Address - Phone:504-708-9431
Mailing Address - Fax:504-766-0489
Practice Address - Street 1:5636 E JUDGE PEREZ DR STE F
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-2946
Practice Address - Country:US
Practice Address - Phone:504-581-8945
Practice Address - Fax:504-766-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health