Provider Demographics
NPI:1659792372
Name:BYFAITHENTERNAL HEALTH CARE
Entity Type:Organization
Organization Name:BYFAITHENTERNAL HEALTH CARE
Other - Org Name:BYFAITHENTERNAL HEALTH AND HEALING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN/RN
Authorized Official - Phone:215-571-5121
Mailing Address - Street 1:2131 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2207
Mailing Address - Country:US
Mailing Address - Phone:215-571-5121
Mailing Address - Fax:215-533-2314
Practice Address - Street 1:2131 GRANITE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2207
Practice Address - Country:US
Practice Address - Phone:215-571-5121
Practice Address - Fax:215-533-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN531355302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4227275OtherENTITY NUMBER FOR BYFAITHENTERNAL HEALTH CARE