Provider Demographics
NPI:1093112633
Name:FAITH HOPE & CHARITY SUPPORTIVE LIVING INC
Entity Type:Organization
Organization Name:FAITH HOPE & CHARITY SUPPORTIVE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-764-6700
Mailing Address - Street 1:2713 S CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-3129
Mailing Address - Country:US
Mailing Address - Phone:414-764-6700
Mailing Address - Fax:414-764-6702
Practice Address - Street 1:2713 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3129
Practice Address - Country:US
Practice Address - Phone:414-764-6700
Practice Address - Fax:414-764-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care