Provider Demographics
NPI:1144816083
Name:FAITH COMMUNITY DISEASE PREVENTION AND HEALTH PROMOTION FOUNDATION
Entity type:Organization
Organization Name:FAITH COMMUNITY DISEASE PREVENTION AND HEALTH PROMOTION FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:LEWIS-BATTLES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP
Authorized Official - Phone:903-284-0056
Mailing Address - Street 1:PO BOX 2362
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-0086
Mailing Address - Country:US
Mailing Address - Phone:903-284-0056
Mailing Address - Fax:
Practice Address - Street 1:319 NECHES STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4931
Practice Address - Country:US
Practice Address - Phone:430-244-9250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty