Provider Demographics
NPI:1134405392
Name:FAITH COMMUNITY HEALTH SERVICES, INC
Entity type:Organization
Organization Name:FAITH COMMUNITY HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-957-7815
Mailing Address - Street 1:4449 177TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4705
Mailing Address - Country:US
Mailing Address - Phone:708-957-7815
Mailing Address - Fax:
Practice Address - Street 1:4449 177TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-4705
Practice Address - Country:US
Practice Address - Phone:708-957-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility