Provider Demographics
NPI:1932668142
Name:FAITHFUL HOME CARE, LLC
Entity Type:Organization
Organization Name:FAITHFUL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNSER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-708-0902
Mailing Address - Street 1:1201 MILITARY RD STE 2-127
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2908
Mailing Address - Country:US
Mailing Address - Phone:501-708-0902
Mailing Address - Fax:501-794-6309
Practice Address - Street 1:622 DENTON
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3424
Practice Address - Country:US
Practice Address - Phone:501-708-0902
Practice Address - Fax:501-794-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230133757Medicaid
AR230136797Medicaid
AR230135732Medicaid