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General NPI Number Information
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NPI Number | 1326354218
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Entity Type | Organization
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Legal Business Name | FAMILY HOME CARE, INC.
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 80 BROADWAY AVE 102
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City | MATTOON
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State | IL
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Zip | 61938-4559
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Country | US
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Telephone | 217-235-0648
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Fax | 217-235-3141
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Provider Business Mailing Address
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Address Line | 80 BROADWAY AVE 102
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City | MATTOON
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State | IL
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Zip | 61938-4559
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Country | US
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Telephone | 217-235-0648
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Fax | 217-235-3141
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. HOLLY ANNE THOMAN
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Credential | RN
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Telephone | 217-273-0593
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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 | 67183339
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License Number State | IL
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