Provider Demographics
NPI:1356498836
Name:FAITH WORKS COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:FAITH WORKS COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-792-7855
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1133
Mailing Address - Country:US
Mailing Address - Phone:252-792-2104
Mailing Address - Fax:252-792-8320
Practice Address - Street 1:3573 MAITLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1239
Practice Address - Country:US
Practice Address - Phone:252-792-2104
Practice Address - Fax:252-792-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301724BMedicaid