Provider Demographics
NPI:1417725680
Name:FAITH TO FATE COMMUNITY MINISTRIES
Entity Type:Organization
Organization Name:FAITH TO FATE COMMUNITY MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:804-418-0876
Mailing Address - Street 1:PO BOX 3586
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-7586
Mailing Address - Country:US
Mailing Address - Phone:804-418-0876
Mailing Address - Fax:
Practice Address - Street 1:720 MOOREFIELD PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3657
Practice Address - Country:US
Practice Address - Phone:804-418-0876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty