Basic Information
Provider Information | |||||||||
NPI: | 1467437871 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BEYONDFAITH HOMECARE AND REHAB LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5601 EXECUTIVE DR STE 250 | ||||||||
Address2: |   | ||||||||
City: | IRVING | ||||||||
State: | TX | ||||||||
PostalCode: | 750382508 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9726773499 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1221 ABRAMS RD STE 107 | ||||||||
Address2: |   | ||||||||
City: | RICHARDSON | ||||||||
State: | TX | ||||||||
PostalCode: | 750815574 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9722038200 | ||||||||
FaxNumber: | 9722038223 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/08/2005 | ||||||||
LastUpdateDate: | 01/18/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | EDWARDS | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | H | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 2142871501 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: | 01/18/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 018326 | TX | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 161785401 | 05 | TX |   | MEDICAID |