Provider Demographics
NPI:1013251883
Name:FAITHFUL COMPANION GROUP HOME
Entity Type:Organization
Organization Name:FAITHFUL COMPANION GROUP HOME
Other - Org Name:PATRECIH TAYLOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRECIH
Authorized Official - Middle Name:REANY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-602-9858
Mailing Address - Street 1:2002 CRAVER MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-8916
Mailing Address - Country:US
Mailing Address - Phone:336-602-9858
Mailing Address - Fax:336-448-0096
Practice Address - Street 1:2002 CRAVER MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-8916
Practice Address - Country:US
Practice Address - Phone:336-602-9858
Practice Address - Fax:336-448-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL034295385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care