Provider Demographics
NPI:1083375364
Name:FAMILY RESIDENTIAL HOME CARE,LLC
Entity Type:Organization
Organization Name:FAMILY RESIDENTIAL HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCKNER
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-529-7387
Mailing Address - Street 1:1201 S WALL AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-4552
Mailing Address - Country:US
Mailing Address - Phone:417-529-7387
Mailing Address - Fax:
Practice Address - Street 1:1201 S WALL AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4552
Practice Address - Country:US
Practice Address - Phone:417-529-7387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care