MEDICARE: FAMILY FIRST GROUP HOME LLC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1720967037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST GROUP HOME LLC

Provider Business Mailing Address
First Line	:	5230 17TH AVE N FL 33710
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5102
Country	:	US
Telephone Number	:	813-400-8646
Fax Number	:	813-870-4000

Provider Business Practice Location Address
First Line	:	5230 17TH AVE N FL 33710
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5102
Country	:	US
Telephone Number	:	813-400-8646
Fax Number	:	813-870-4000

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MARY GRACE NICHOLS
Credential	:
Telephone Number	:	813-400-8646

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	08/29/2025

Similar Medicare Providers

1306248075 — DR. VIRMARIE DIAZ FERNANDEZ MD
Practice Location Address:

7901 4TH ST N STE 5102
ST PETERSBURG, FL
33702-4305

Practice Phone: 352-308-1485
Practice Fax: 352-329-4379

1023729084 — BETTER CONNECTIONS
Practice Location Address:

7901 4TH ST N STE 5102
ST PETERSBURG, FL
33702-4305

Practice Phone: 352-308-1485
Practice Fax: 352-329-4379

1881375541 — MRS. BONNIE K BROWN
Practice Location Address:

7326 10TH ST N
ST PETERSBURG, FL
33702-5102

Practice Phone: 727-522-1975
Practice Fax:

1003882150 — DR. KAJAL DASGUPTA M.D.
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-2424
Practice Fax:

1881646115 — MS. MELISSA RYAN STRAUSS P.A.
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-2424
Practice Fax:

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

Directions to “FAMILY FIRST GROUP HOME LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.