Provider Demographics
NPI:1255672937
Name:FAITH HOME FOR GIRLS INC
Entity Type:Organization
Organization Name:FAITH HOME FOR GIRLS INC
Other - Org Name:HANDS ADULT DAYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WYLEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDP
Authorized Official - Phone:706-653-0828
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-0215
Mailing Address - Country:US
Mailing Address - Phone:706-653-0828
Mailing Address - Fax:706-321-1272
Practice Address - Street 1:1228 24TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1376
Practice Address - Country:US
Practice Address - Phone:706-653-0828
Practice Address - Fax:706-321-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
GANO LICENSE REQUIREDE251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA44829394AMedicaid
GA44829394BMedicaid