MEDICARE: FAMILY LIFE CARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	299992645	OTHER	FL	HOME HEALTH AGENCY LICENSE

General Provider Information

NPI Number	:	1750934659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY LIFE CARE, INC.

Provider Business Mailing Address
First Line	:	555 WELLS RD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2923
Country	:	US
Telephone Number	:	904-579-1581
Fax Number	:	904-375-1673

Provider Business Practice Location Address
First Line	:	406 OHIO AVE S
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32064-3218
Country	:	US
Telephone Number	:	386-364-5515
Fax Number	:	386-364-5648

Authorized Official
Title or Position	:	CEO
Name	:	DAVID MCMULLEN
Credential	:
Telephone Number	:	904-579-1581

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	07/20/2020

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Directions to “FAMILY LIFE CARE, INC. ” Practice Location

Language	Start Address	Practice Location

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