Provider Demographics
NPI:1609174499
Name:FAITH IN ACTION OF DODGE COUNTY, KENYON, AND NERSTRAND
Entity Type:Organization
Organization Name:FAITH IN ACTION OF DODGE COUNTY, KENYON, AND NERSTRAND
Other - Org Name:FAITH IN ACTION OF DODGE COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-789-7104
Mailing Address - Street 1:127 GUNDERSON BLVD
Mailing Address - Street 2:ATTN: FAITH IN ACTION
Mailing Address - City:KENYON
Mailing Address - State:MN
Mailing Address - Zip Code:55946-1014
Mailing Address - Country:US
Mailing Address - Phone:507-789-8887
Mailing Address - Fax:507-789-8843
Practice Address - Street 1:127 GUNDERSON BLVD
Practice Address - Street 2:ATTN: FAITH IN ACTION
Practice Address - City:KENYON
Practice Address - State:MN
Practice Address - Zip Code:55946-1014
Practice Address - Country:US
Practice Address - Phone:507-789-8887
Practice Address - Fax:507-789-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care