Provider Demographics
NPI:1780981316
Name:FAITHWAY TRANSPORTATION
Entity type:Organization
Organization Name:FAITHWAY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:LEVELLE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:313-682-7186
Mailing Address - Street 1:1195 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1028
Mailing Address - Country:US
Mailing Address - Phone:313-682-7186
Mailing Address - Fax:
Practice Address - Street 1:621 N 5TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5812
Practice Address - Country:US
Practice Address - Phone:313-682-7186
Practice Address - Fax:734-981-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01413L343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)