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General NPI Number Information
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NPI Number | 1154320695
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Entity Type | Organization
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Legal Business Name | FAMILY HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 1208 CASEY ST
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City | POTOSI
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State | MO
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Zip | 63664-1214
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Country | US
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Telephone | 573-438-6140
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Fax | 573-438-8613
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Provider Business Mailing Address
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Address Line | 1208 CASEY ST
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City | POTOSI
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State | MO
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Zip | 63664-1214
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Country | US
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Telephone | 573-438-6140
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Fax | 573-438-8613
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DIANA LYNN HUMPHREY
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Credential | RN
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Telephone | 573-438-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 730
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License Number State | MO
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