Provider Demographics
NPI:1447843610
Name:GOOD FAITH HEALTH CARE LLC
Entity type:Organization
Organization Name:GOOD FAITH HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPAUL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:754-204-3096
Mailing Address - Street 1:6621 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-2113
Mailing Address - Country:US
Mailing Address - Phone:754-204-3096
Mailing Address - Fax:
Practice Address - Street 1:6621 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-2113
Practice Address - Country:US
Practice Address - Phone:754-204-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11000974OtherSTATE OF FLORIDA DIVISION OF MEDICAL QUALITY