Provider Demographics
NPI:1023137627
Name:FAITHFUL SERVANT IN HOME CARE
Entity type:Organization
Organization Name:FAITHFUL SERVANT IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JERMILLS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-405-1467
Mailing Address - Street 1:1801 N TRYON ST STE B203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2741
Mailing Address - Country:US
Mailing Address - Phone:704-405-1467
Mailing Address - Fax:704-405-1468
Practice Address - Street 1:1801 N TRYON ST STE B203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2741
Practice Address - Country:US
Practice Address - Phone:704-405-1467
Practice Address - Fax:704-405-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418363OtherCOMMUNITY ALTERNATIVE