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General NPI Number Information
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NPI Number | 1265015929
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Entity Type | Organization
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Legal Business Name | FAMILY ADULT SITTING SERVICES, (FASS),LLC
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 112 HENDERSON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401
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Country | US
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Telephone | 850-358-6175
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Fax |
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Provider Business Mailing Address
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Address Line | 2319 S HIGHWAY 77 UNIT 1824
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City | LYNN HAVEN
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State | FL
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Zip | 32444-7773
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Country | US
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Telephone | 850-358-6175
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOMINIQUE N WOULLARD
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Credential |
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Telephone | 850-358-6175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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