Healthcare Provider Details

I. General information

NPI: 1154320695
Provider Name (Legal Business Name): FAMILY HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 CASEY ST
POTOSI MO
63664-1214
US

IV. Provider business mailing address

1208 CASEY ST
POTOSI MO
63664-1214
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-6140
  • Fax: 573-438-8613
Mailing address:
  • Phone: 573-438-6140
  • Fax: 573-438-8613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number730
License Number StateMO

VIII. Authorized Official

Name: MS. DIANA LYNN HUMPHREY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 573-438-6140