MEDICARE: FAMILY CARE 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1962154336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE LLC

Provider Business Mailing Address
First Line	:	4019 GRAND ISLE DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-2323
Country	:	US
Telephone Number	:	757-828-8133
Fax Number	:

Provider Business Practice Location Address
First Line	:	4019 GRAND ISLE DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-2323
Country	:	US
Telephone Number	:	757-828-8133
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. IGNACIO GOMEZ
Credential	:
Telephone Number	:	757-828-8133

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	04/24/2024

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