- Enrollment id
- O20171218001134
- Enrollment state
- MO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1104345164
- Multiple npi flag
- N
- Ccn
- 267666
- Associate id
- 8022376250
- Organization name
- FAITH HEALTHCARE LLC
- Doing business as name
- FAITH HOME HEALTHCARE
- Incorporation date
- 2017-09-11
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2700 NE KENDALLWOOD PKWY
- Address line 2
- STE 100
- City
- GLADSTONE
- State
- MO
- Zip code
- 641192060