Provider Demographics
NPI:1508500497
Name:FAITH'S SHINING LIGHT HOME HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:FAITH'S SHINING LIGHT HOME HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-517-0426
Mailing Address - Street 1:3300 LUMINOSO LN E
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2336
Mailing Address - Country:US
Mailing Address - Phone:512-517-0426
Mailing Address - Fax:
Practice Address - Street 1:3300 LUMINOSO LN E
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2336
Practice Address - Country:US
Practice Address - Phone:512-517-0426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion