Provider Demographics
NPI:1790396521
Name:FAITHFUL LIVING HOME HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:FAITHFUL LIVING HOME HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:REENE
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-323-9395
Mailing Address - Street 1:3846 W WISCONSIN AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3175
Mailing Address - Country:US
Mailing Address - Phone:414-323-9395
Mailing Address - Fax:414-755-1337
Practice Address - Street 1:3846 W WISCONSIN AVE APT 110
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3175
Practice Address - Country:US
Practice Address - Phone:414-323-9395
Practice Address - Fax:414-755-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health