MEDICARE: FAMILY PRIVATE CARE ALABAMA, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1104364892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRIVATE CARE ALABAMA, LLC

Provider Business Mailing Address
First Line	:	1905 WOODSTOCK RD
Second Line	:	SUITE 5200
City	:	ROSWELL
State	:	GA
Zip	:	30075-5616
Country	:	US
Telephone Number	:	678-620-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 OFFICE PARK DR
Second Line	:	SUITE 240
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-870-8855
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TONY PLUMMER
Credential	:
Telephone Number	:	678-620-3064

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	02/02/2017

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