Provider Demographics
NPI:1598537151
Name:FAITH RESIDENTIAL HOMES LLC
Entity Type:Organization
Organization Name:FAITH RESIDENTIAL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELLEN
Authorized Official - Middle Name:ALEM
Authorized Official - Last Name:DESSALEGN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-617-9859
Mailing Address - Street 1:5414 JASLIE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-2650
Mailing Address - Country:US
Mailing Address - Phone:704-617-9859
Mailing Address - Fax:
Practice Address - Street 1:5823 HEWITT DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0219
Practice Address - Country:US
Practice Address - Phone:704-617-9859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities