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General NPI Number Information
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NPI Number | 1801221627
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Entity Type | Organization
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Legal Business Name | FAMILY LIFE, LLC
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 422 11TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-4233
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Country | US
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Telephone | 208-442-8200
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Fax | 208-442-1418
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Provider Business Mailing Address
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Address Line | 422 11TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-4233
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Country | US
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Telephone | 208-442-8200
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Fax | 208-442-1418
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT GRAHAM RICHMOND
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Credential |
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Telephone | 208-429-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | RC-1059
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License Number State | ID
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