Provider Demographics
NPI:1760782023
Name:FAITHFUL SHEPHARD'S HOME CARE , LLC
Entity Type:Organization
Organization Name:FAITHFUL SHEPHARD'S HOME CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-884-5694
Mailing Address - Street 1:621 E SECOND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-884-5694
Mailing Address - Fax:
Practice Address - Street 1:1390 WALKUP AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110
Practice Address - Country:US
Practice Address - Phone:704-296-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health