Healthcare Provider Details

I. General information

NPI: 1336768811
Provider Name (Legal Business Name): A FAMILY FRIEND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N PERSON ST
RALEIGH NC
27604-1216
US

IV. Provider business mailing address

4133 BAY RUM LN
RALEIGH NC
27610-6333
US

V. Phone/Fax

Practice location:
  • Phone: 919-626-4917
  • Fax:
Mailing address:
  • Phone: 919-626-4917
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: KIMBLE BREAZELL
Title or Position: CEO/ FOUNDER
Credential:
Phone: 919-626-4917