MEDICARE: FAMILY FOCUS HEALTH SERVICE 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1194090530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FOCUS HEALTH SERVICE LLC

Provider Business Mailing Address
First Line	:	3129 PARK MEADOW DR
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-2061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3129 PARK MEADOW DR
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48362-2061
Country	:	US
Telephone Number	:	248-766-7283
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHANDRA G
Credential	:
Telephone Number	:	248-766-7283

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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