Provider Demographics
NPI:1740421171
Name:FAITH-WORKS HEALTH AND WELLNESS NETWORK
Entity Type:Organization
Organization Name:FAITH-WORKS HEALTH AND WELLNESS NETWORK
Other - Org Name:BRIDGE RESEARCH FOUNDATION INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:II
Authorized Official - Credentials:ED D
Authorized Official - Phone:713-884-0884
Mailing Address - Street 1:4112 AUSTIN ST
Mailing Address - Street 2:STREET
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4813
Mailing Address - Country:US
Mailing Address - Phone:713-884-0884
Mailing Address - Fax:713-583-5877
Practice Address - Street 1:4112 AUSTIN ST
Practice Address - Street 2:STREET
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4813
Practice Address - Country:US
Practice Address - Phone:713-884-0884
Practice Address - Fax:713-583-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-15
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty