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General NPI Number Information
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NPI Number | 1396215984
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Entity Type | Organization
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Legal Business Name | VICKSBURG FAMILY HOME CARE,LLC
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 706 W PRAIRIE ST
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City | VICKSBURG
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State | MI
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Zip | 49097-4909
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Country | US
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Telephone | 269-475-5211
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Fax | 269-315-5100
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Provider Business Mailing Address
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Address Line | 706 W PRAIRIE ST
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City | VICKSBURG
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State | MI
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Zip | 49097
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Country | US
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Telephone | 269-475-5211
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Fax | 269-315-5100
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TERRY L BARNES JR.
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Credential |
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Telephone | 269-475-5211
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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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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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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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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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