Healthcare Provider Details

I. General information

NPI: 1932787173
Provider Name (Legal Business Name): FAMILY HOME HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HOWELL ST
GUTHRIE KY
42234
US

IV. Provider business mailing address

102 HOWELL ST
GUTHRIE KY
42234
US

V. Phone/Fax

Practice location:
  • Phone: 229-234-0062
  • Fax:
Mailing address:
  • Phone: 229-234-0062
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WARREN
Title or Position: HOME HEALTHCARE PROVIDER
Credential:
Phone: 229-234-0062