Provider Demographics
NPI:1669707618
Name:MY FAITH INC
Entity type:Organization
Organization Name:MY FAITH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-831-1231
Mailing Address - Street 1:3393 CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-3522
Mailing Address - Country:US
Mailing Address - Phone:901-238-4071
Mailing Address - Fax:901-791-2572
Practice Address - Street 1:2506 MOUNT MORIAH RD
Practice Address - Street 2:SUITE B415
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1511
Practice Address - Country:US
Practice Address - Phone:901-238-4071
Practice Address - Fax:901-791-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343900000X
TNL000000004203253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000448Medicaid
TNH445202Medicaid