Provider Demographics
NPI:1700565090
Name:FAITH HEART HOMECARE
Entity Type:Organization
Organization Name:FAITH HEART HOMECARE
Other - Org Name:FAITH HEART HOMECARE CEO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYNISHIA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-462-6099
Mailing Address - Street 1:125 EAST 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-0593
Mailing Address - Country:US
Mailing Address - Phone:601-287-8012
Mailing Address - Fax:601-287-8219
Practice Address - Street 1:125 EAST 1ST ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-0593
Practice Address - Country:US
Practice Address - Phone:601-287-8012
Practice Address - Fax:601-287-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care