Healthcare Provider Details

I. General information

NPI: 1285604140
Provider Name (Legal Business Name): FAMILY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE SUITE 103 E
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

3854 AMERICAN WAY SUITE A
BATON ROUGE LA
70816-4013
US

V. Phone/Fax

Practice location:
  • Phone: 270-852-4811
  • Fax: 270-852-4812
Mailing address:
  • Phone: 225-292-2031
  • Fax: 252-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number150176
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150176
License Number StateKY

VIII. Authorized Official

Name: MR. PAUL B KUSSEROW
Title or Position: PRESIDENT
Credential:
Phone: 225-292-2031