Provider Demographics
NPI:1821338518
Name:FARETH HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:FARETH HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TEMILADE
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-485-3166
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-1071
Mailing Address - Country:US
Mailing Address - Phone:770-485-3166
Mailing Address - Fax:770-485-3240
Practice Address - Street 1:3650 LONG LAKE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7652
Practice Address - Country:US
Practice Address - Phone:770-485-3166
Practice Address - Fax:770-485-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048-R-0964251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health