Healthcare Provider Details

I. General information

NPI: 1265015929
Provider Name (Legal Business Name): FAMILY ADULT SITTING SERVICES, (FASS),LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HENDERSON AVE
PANAMA CITY FL
32401
US

IV. Provider business mailing address

2319 S HIGHWAY 77 UNIT 1824
LYNN HAVEN FL
32444-7773
US

V. Phone/Fax

Practice location:
  • Phone: 850-358-6175
  • Fax:
Mailing address:
  • Phone: 850-358-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE N WOULLARD
Title or Position: CEO
Credential:
Phone: 850-358-6175