Provider Demographics
NPI:1295918936
Name:FAITH HOMES 2
Entity type:Organization
Organization Name:FAITH HOMES 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:WAMBUI
Authorized Official - Last Name:MUCUGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-279-8060
Mailing Address - Street 1:PO BOX 40155
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-0155
Mailing Address - Country:US
Mailing Address - Phone:919-279-8060
Mailing Address - Fax:
Practice Address - Street 1:1210 RIVERBIRCH DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8850
Practice Address - Country:US
Practice Address - Phone:919-266-5956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-689320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities