Healthcare Provider Details

I. General information

NPI: 1124433271
Provider Name (Legal Business Name): FAMILY FIRST-ARMADA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22905 W MAIN ST SUITE 100
ARMADA MI
48005-3247
US

IV. Provider business mailing address

PO BOX 536
ARMADA MI
48005-0536
US

V. Phone/Fax

Practice location:
  • Phone: 810-395-4840
  • Fax: 810-395-7551
Mailing address:
  • Phone: 810-395-4840
  • Fax: 810-395-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOREN DECARLO
Title or Position: OWNER
Credential: D.O.
Phone: 810-395-4840