Healthcare Provider Details

I. General information

NPI: 1528683919
Provider Name (Legal Business Name): URBAN FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 AUGUSTA LN
WEST LAFAYETTE IN
47906-8721
US

IV. Provider business mailing address

336 AUGUSTA LN
WEST LAFAYETTE IN
47906-8721
US

V. Phone/Fax

Practice location:
  • Phone: 765-464-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY WILLIAMS
Title or Position: CEO
Credential: MD
Phone: 317-441-6876