Provider Demographics
NPI:1205321791
Name:FAITH PRIMARY HOME CARE , LLC
Entity type:Organization
Organization Name:FAITH PRIMARY HOME CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-451-7254
Mailing Address - Street 1:813 EL GATO RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-4124
Mailing Address - Country:US
Mailing Address - Phone:956-451-7254
Mailing Address - Fax:888-559-7871
Practice Address - Street 1:813 EL GATO RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-4124
Practice Address - Country:US
Practice Address - Phone:956-451-7254
Practice Address - Fax:888-559-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty