Provider Demographics
NPI:1790967792
Name:THE FAITH-COURAGE HOUSE, LLC
Entity Type:Organization
Organization Name:THE FAITH-COURAGE HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-453-8485
Mailing Address - Street 1:PO BOX 5884
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-5884
Mailing Address - Country:US
Mailing Address - Phone:336-884-7061
Mailing Address - Fax:336-884-0502
Practice Address - Street 1:1106 DELK DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3420
Practice Address - Country:US
Practice Address - Phone:336-884-7061
Practice Address - Fax:336-884-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-841322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children