Provider Demographics
NPI:1972936987
Name:FAITH HOUSE GROUP HOME
Entity type:Organization
Organization Name:FAITH HOUSE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPERITOR
Authorized Official - Prefix:
Authorized Official - First Name:LATARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:832-716-0408
Mailing Address - Street 1:9393 TIDWELL RD
Mailing Address - Street 2:APT 3111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77078-3429
Mailing Address - Country:US
Mailing Address - Phone:832-716-0408
Mailing Address - Fax:
Practice Address - Street 1:9393 TIDWELL RD
Practice Address - Street 2:APT 3111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77078-3429
Practice Address - Country:US
Practice Address - Phone:832-716-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities