Provider Demographics
NPI:1497309744
Name:FAITHFULLY DIVINE CONCIERGE
Entity Type:Organization
Organization Name:FAITHFULLY DIVINE CONCIERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-916-0229
Mailing Address - Street 1:320 CHANDLER BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4324
Mailing Address - Country:US
Mailing Address - Phone:404-916-0229
Mailing Address - Fax:
Practice Address - Street 1:320 CHANDLER BLUFF CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4324
Practice Address - Country:US
Practice Address - Phone:404-916-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health