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General NPI Number Information
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NPI Number | 1134366339
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST CARE SERVICES, LLC
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Dates
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Enumeration Date | 01/10/2009
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Last Update Date | 01/10/2009
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Provider Practice Location Address
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Address Line | 23760 RAVEN AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-3406
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Country | US
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Telephone | 586-219-5132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 692
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-0692
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Country | US
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Telephone | 586-219-5132
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARLENE TACY WALCZAK
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Credential |
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Telephone | 586-219-5132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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