Provider Demographics
NPI:1609503952
Name:FAITHANDLOVE MEDICAL TRANSPORTATION AND GROUP HOME LLC
Entity Type:Organization
Organization Name:FAITHANDLOVE MEDICAL TRANSPORTATION AND GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BASS-MARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-875-0659
Mailing Address - Street 1:617 MARINERS WAY APT B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-7731
Mailing Address - Country:US
Mailing Address - Phone:352-875-0659
Mailing Address - Fax:
Practice Address - Street 1:617 MARINERS WAY APT B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-7731
Practice Address - Country:US
Practice Address - Phone:352-875-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)