Provider Demographics
NPI:1033541834
Name:OUR FAMILY CARE HOME LLC
Entity Type:Organization
Organization Name:OUR FAMILY CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CODAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-630-2762
Mailing Address - Street 1:810 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6501
Mailing Address - Country:US
Mailing Address - Phone:760-630-2762
Mailing Address - Fax:760-330-9561
Practice Address - Street 1:810 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6501
Practice Address - Country:US
Practice Address - Phone:760-630-2762
Practice Address - Fax:760-330-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603157310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility