Provider Demographics
NPI:1356693493
Name:FAITH PALLIATIVE CARE MANAGEMENT, INC.
Entity type:Organization
Organization Name:FAITH PALLIATIVE CARE MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:903-663-5300
Mailing Address - Street 1:4362 US HIGHWAY 259 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7674
Mailing Address - Country:US
Mailing Address - Phone:903-663-5300
Mailing Address - Fax:903-663-5302
Practice Address - Street 1:4362 US HIGHWAY 259 N
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7674
Practice Address - Country:US
Practice Address - Phone:903-663-5300
Practice Address - Fax:903-663-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-14
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based