Provider Demographics
NPI:1013364512
Name:FAITHFUL NUBIAN SERVICES, LLC
Entity Type:Organization
Organization Name:FAITHFUL NUBIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-419-3941
Mailing Address - Street 1:410 HUSTINGS LN
Mailing Address - Street 2:UNIT E
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2807
Mailing Address - Country:US
Mailing Address - Phone:757-491-3941
Mailing Address - Fax:757-325-8283
Practice Address - Street 1:410 HUSTINGS LN
Practice Address - Street 2:UNIT E
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2807
Practice Address - Country:US
Practice Address - Phone:757-491-3941
Practice Address - Fax:757-325-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)