MEDICARE: THE FAMILY ENRICHMENT CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	11897	FL

General Provider Information

NPI Number	:	1043510324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY ENRICHMENT CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 11325
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33680-1325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 E 21ST AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-1910
Country	:	US
Telephone Number	:	813-247-2026
Fax Number	:	813-247-2190

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. OLGA STIRRUP
Credential	:
Telephone Number	:	813-237-2530

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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