Provider Demographics
NPI:1689829657
Name:FAITH HOUSE ASSISTED LIVING FACILITLY
Entity Type:Organization
Organization Name:FAITH HOUSE ASSISTED LIVING FACILITLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-366-9961
Mailing Address - Street 1:335 FOSTER CV
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-8003
Mailing Address - Country:US
Mailing Address - Phone:407-366-9961
Mailing Address - Fax:
Practice Address - Street 1:335 FOSTER CV
Practice Address - Street 2:
Practice Address - City:CHULUOTA
Practice Address - State:FL
Practice Address - Zip Code:32766-8003
Practice Address - Country:US
Practice Address - Phone:407-366-9961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10995310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility