Provider Demographics
NPI:1821690777
Name:FAITH HEALTHCARE, INC.
Entity Type:Organization
Organization Name:FAITH HEALTHCARE, INC.
Other - Org Name:NANCY FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:066-425-5768
Mailing Address - Fax:606-425-5769
Practice Address - Street 1:9919 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-9003
Practice Address - Country:US
Practice Address - Phone:606-288-0019
Practice Address - Fax:606-288-0020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-14
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty