=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306383450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY FIRST OPERATING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2017
-----------------------------------------------------
Last Update Date | 01/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 MEDICAL CENTER BLVD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37334-2685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-438-9035
-----------------------------------------------------
Fax | 931-438-9037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 MEDICAL CENTER BLVD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37334-2685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MELISSA FLOWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 931-438-9035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 0000000261
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------