MEDICARE: FAMILY STYLE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1013660927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY STYLE CARE

Provider Business Mailing Address
First Line	:	2847 MORNINGSIDE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3527
Country	:	US
Telephone Number	:	619-856-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2847 MORNINGSIDE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3527
Country	:	US
Telephone Number	:	619-856-4968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSIE HULSEY
Credential	:
Telephone Number	:	619-519-0025

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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Directions to “FAMILY STYLE CARE ” Practice Location

Language	Start Address	Practice Location

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