Provider Demographics
NPI:1891404752
Name:FAITHFUL JOURNEY HOME CARE
Entity Type:Organization
Organization Name:FAITHFUL JOURNEY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-216-4646
Mailing Address - Street 1:PO BOX 7502
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-7502
Mailing Address - Country:US
Mailing Address - Phone:432-216-4646
Mailing Address - Fax:
Practice Address - Street 1:601 N MARIENFELD ST STE 411
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-4374
Practice Address - Country:US
Practice Address - Phone:432-216-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care