MEDICARE: FAMILY PRIMARY HOME CARE SERVICES, INC.

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1487027116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRIMARY HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	608 MORROW ST STE 102A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-1348
Country	:	US
Telephone Number	:	512-731-6461
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 MORROW ST STE 102A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-1348
Country	:	US
Telephone Number	:	512-731-6461
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FELICIA C OJIYI
Credential	:	R.N
Telephone Number	:	512-731-6461

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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