Provider Demographics
NPI:1801212097
Name:FAITH HOME CARE ALF INC.
Entity Type:Organization
Organization Name:FAITH HOME CARE ALF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-689-1922
Mailing Address - Street 1:114 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-8000
Mailing Address - Country:US
Mailing Address - Phone:813-689-1922
Mailing Address - Fax:813-689-1900
Practice Address - Street 1:114 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-8000
Practice Address - Country:US
Practice Address - Phone:813-689-1922
Practice Address - Fax:813-689-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12447310400000X
313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility