Provider Demographics
NPI:1790541431
Name:FAITH HEALTHCARE INC
Entity Type:Organization
Organization Name:FAITH HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ANTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-425-5768
Mailing Address - Street 1:521 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-9503
Mailing Address - Country:US
Mailing Address - Phone:606-425-5768
Mailing Address - Fax:
Practice Address - Street 1:325 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2712
Practice Address - Country:US
Practice Address - Phone:606-331-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)