Provider Demographics
NPI:1760058119
Name:FAITHFUL SENIORCARE
Entity Type:Organization
Organization Name:FAITHFUL SENIORCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHASTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-250-5366
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-0095
Mailing Address - Country:US
Mailing Address - Phone:317-250-5366
Mailing Address - Fax:
Practice Address - Street 1:3670 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3428
Practice Address - Country:US
Practice Address - Phone:317-250-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)