Provider Demographics
NPI:1457800245
Name:WALK IN FAITH, PHC, LLC
Entity Type:Organization
Organization Name:WALK IN FAITH, PHC, LLC
Other - Org Name:WALK IN FAITH, PHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-241-1503
Mailing Address - Street 1:111 GIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4109
Mailing Address - Country:US
Mailing Address - Phone:956-626-1422
Mailing Address - Fax:844-315-7635
Practice Address - Street 1:111 GIL DR
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4109
Practice Address - Country:US
Practice Address - Phone:956-626-1422
Practice Address - Fax:844-315-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0802517983Medicaid