Healthcare Provider Details

I. General information

NPI: 1871132373
Provider Name (Legal Business Name): FAMILY TYME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 OAKWOOD RD
ORANGE CITY FL
32763-5028
US

IV. Provider business mailing address

960 OAKWOOD RD
ORANGE CITY FL
32763-5028
US

V. Phone/Fax

Practice location:
  • Phone: 386-218-0402
  • Fax: 386-456-4974
Mailing address:
  • Phone: 386-218-0402
  • Fax: 386-456-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PERRY LEE DAVIS
Title or Position: CFO/OWNER
Credential:
Phone: 386-320-2467