Basic Information
| Provider Information | |||||||||
| NPI: | 1346247434 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEYONDFAITH HOMECARE & REHAB, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BEYONDFAITH HOMECARE & REHAB OF WICHITA FALLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 EXECUTIVE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750382508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726773499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6410 98TH STREET | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067985683 | ||||||||
| FaxNumber: | 8067982443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VOGEL | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 2102836243 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 162453801 | 05 | TX | MEDICAID | 162453803 | 05 | TX | MEDICAID | 45D1017319 | 01 | CLIA | OTHER | 162453802 | 05 | TX | MEDICAID |