Provider Demographics
NPI:1639962590
Name:FAITH SMALL AS A MUSTARD SEED
Entity type:Organization
Organization Name:FAITH SMALL AS A MUSTARD SEED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LADRECA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-250-7751
Mailing Address - Street 1:12045 SW 218TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2834
Mailing Address - Country:US
Mailing Address - Phone:786-250-7751
Mailing Address - Fax:786-250-7751
Practice Address - Street 1:12045 SW 218TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2834
Practice Address - Country:US
Practice Address - Phone:786-250-7751
Practice Address - Fax:786-250-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services