Healthcare Provider Details

I. General information

NPI: 1295254431
Provider Name (Legal Business Name): MY FAMILY SERVICE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AVENUE C STE 105A
MADISON WV
25130-1100
US

IV. Provider business mailing address

PO BOX 47
PECKS MILL WV
25547-0047
US

V. Phone/Fax

Practice location:
  • Phone: 304-307-2434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARRIE HUNTER
Title or Position: OWNER
Credential: MA
Phone: 304-946-0097