Provider Demographics
NPI:1275917254
Name:FAITH HOME CARE PRACTITIONERS, PLLC
Entity Type:Organization
Organization Name:FAITH HOME CARE PRACTITIONERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-996-4443
Mailing Address - Street 1:34 NE BOISTFORT ST
Mailing Address - Street 2:STE. 124
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2600
Mailing Address - Country:US
Mailing Address - Phone:360-996-4443
Mailing Address - Fax:360-242-0049
Practice Address - Street 1:34 NE BOISTFORT ST
Practice Address - Street 2:STE. 124
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2600
Practice Address - Country:US
Practice Address - Phone:360-996-4443
Practice Address - Fax:360-242-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60396765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty