Provider Demographics
NPI:1467696781
Name:FAITH RESIDENTIAL HOUSE INC #1
Entity Type:Organization
Organization Name:FAITH RESIDENTIAL HOUSE INC #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-374-4311
Mailing Address - Street 1:6840 BRIERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-3618
Mailing Address - Country:US
Mailing Address - Phone:241-374-9900
Mailing Address - Fax:214-374-4311
Practice Address - Street 1:6840 BRIERFIELD CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232
Practice Address - Country:US
Practice Address - Phone:214-374-4311
Practice Address - Fax:214-374-4311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH RESIDENTIAL HOUSE INC #2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06155420302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization