Provider Demographics
NPI:1336581982
Name:WALK OF FAITH HOSPICE CARE LLC
Entity Type:Organization
Organization Name:WALK OF FAITH HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM.
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISHOLA
Authorized Official - Middle Name:LATRAY
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-488-4580
Mailing Address - Street 1:543 SUITE B HWY 80 WEST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-0543
Mailing Address - Country:US
Mailing Address - Phone:601-488-4580
Mailing Address - Fax:601-488-4580
Practice Address - Street 1:543 HIGHWAY 80 W
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4193
Practice Address - Country:US
Practice Address - Phone:601-488-4580
Practice Address - Fax:601-488-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS25WOF251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based