Provider Demographics
NPI:1689279317
Name:FAITHFULNESSCARELLC
Entity Type:Organization
Organization Name:FAITHFULNESSCARELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAROR
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:MANDELA
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-669-4901
Mailing Address - Street 1:2450 HOLLYWOOD BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6639
Mailing Address - Country:US
Mailing Address - Phone:954-669-4901
Mailing Address - Fax:786-221-4277
Practice Address - Street 1:2450 HOLLYWOOD BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6639
Practice Address - Country:US
Practice Address - Phone:954-669-4901
Practice Address - Fax:786-221-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health