Provider Demographics
NPI:1245337948
Name:FAITH HOME CARE SERVICES
Entity type:Organization
Organization Name:FAITH HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-610-0434
Mailing Address - Street 1:1010 LORELEI DR
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-1368
Mailing Address - Country:US
Mailing Address - Phone:224-610-0434
Mailing Address - Fax:708-589-4349
Practice Address - Street 1:1010 LORELEI
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-1368
Practice Address - Country:US
Practice Address - Phone:224-610-0434
Practice Address - Fax:708-589-4349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-17
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6391-153-4251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-60525-01Medicaid