Provider Demographics
NPI:1760897771
Name:WALK BY FAITH ADULT HEALTH & DAY CARE LLC
Entity Type:Organization
Organization Name:WALK BY FAITH ADULT HEALTH & DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEALTH CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-891-2770
Mailing Address - Street 1:1004 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4708
Mailing Address - Country:US
Mailing Address - Phone:910-891-2770
Mailing Address - Fax:910-891-2771
Practice Address - Street 1:1004 W BROAD ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4708
Practice Address - Country:US
Practice Address - Phone:910-891-2770
Practice Address - Fax:910-891-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPE KX5D1Z7TA261QA0600X
NCPE-KX5D1Z7TA305S00000X, 311Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No305S00000XManaged Care OrganizationsPoint of Service
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40312372Medicaid