Provider Demographics
NPI:1982171419
Name:FAITH GROUP HOME INC.
Entity Type:Organization
Organization Name:FAITH GROUP HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-396-1247
Mailing Address - Street 1:4548 POWDERHORN PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8940
Mailing Address - Country:US
Mailing Address - Phone:352-396-1247
Mailing Address - Fax:352-708-6382
Practice Address - Street 1:4548 POWDERHORN PLACE DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8940
Practice Address - Country:US
Practice Address - Phone:352-396-1247
Practice Address - Fax:352-708-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health