MEDICARE: FAMILY TO FAMILY 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	251E00000X	Home Health Agency	200629410310	CA

General Provider Information

NPI Number	:	1508936915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TO FAMILY LLC

Provider Business Mailing Address
First Line	:	5482 WILSHIRE BLVD
Second Line	:	SUITE 1524
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4218
Country	:	US
Telephone Number	:	310-215-9928
Fax Number	:	310-215-9929

Provider Business Practice Location Address
First Line	:	5482 WILSHIRE BLVD
Second Line	:	SUITE 1524
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4218
Country	:	US
Telephone Number	:	310-215-9928
Fax Number	:	310-215-9929

Authorized Official
Title or Position	:	CEO
Name	:	MR. RUSSELL LAMON EDMOND
Credential	:
Telephone Number	:	310-215-9928

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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Directions to “FAMILY TO FAMILY LLC ” Practice Location

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