Healthcare Provider Details

I. General information

NPI: 1346893625
Provider Name (Legal Business Name): SUPPORT FOR FAMILY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 HOWE AVE STE 206
SACRAMENTO CA
95825-3362
US

IV. Provider business mailing address

1333 HOWE AVE STE 206
SACRAMENTO CA
95825-3362
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-9111
  • Fax: 916-209-6676
Mailing address:
  • Phone: 916-924-9111
  • Fax: 916-209-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON WU
Title or Position: PRESIDENT
Credential:
Phone: 916-209-6676