Provider Demographics
NPI:1487881306
Name:FAITH WORKS HEALTH AND WELLNESS NETWORK
Entity type:Organization
Organization Name:FAITH WORKS HEALTH AND WELLNESS NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:II
Authorized Official - Credentials:ED D
Authorized Official - Phone:713-884-0884
Mailing Address - Street 1:4112 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4813
Mailing Address - Country:US
Mailing Address - Phone:713-884-0884
Mailing Address - Fax:713-583-5877
Practice Address - Street 1:4112 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4813
Practice Address - Country:US
Practice Address - Phone:713-884-0884
Practice Address - Fax:713-583-5877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGE RESEARCH FOUNDATION INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230335101YP2500X, 163W00000X
171M00000X, 343900000X
TXK1282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty