Provider Demographics
NPI:1356307904
Name:FAITH HOSPICE, INC.
Entity Type:Organization
Organization Name:FAITH HOSPICE, INC.
Other - Org Name:FAITH HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN
Authorized Official - Phone:256-215-6006
Mailing Address - Street 1:625 ALEX CITY SHOPPING CTR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-2787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 ALEX CITY SHOPPING CTR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-2787
Practice Address - Country:US
Practice Address - Phone:256-215-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11748251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL012-250OtherBLUE CROSS PREFERRED
ALPIC1581EMedicaid
AL01-1581Medicare ID - Type UnspecifiedHOSPICE