Provider Demographics
NPI:1265607527
Name:FAITH & GRACE INC.
Entity type:Organization
Organization Name:FAITH & GRACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LA JUETA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-946-3161
Mailing Address - Street 1:44134 CAMELLIA ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535
Mailing Address - Country:US
Mailing Address - Phone:661-946-3161
Mailing Address - Fax:
Practice Address - Street 1:44134 CAMELLIA ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535
Practice Address - Country:US
Practice Address - Phone:661-946-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition