Provider Demographics
NPI:1083826606
Name:FAMILY CARE NETWORK, INC.
Entity Type:Organization
Organization Name:FAMILY CARE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-781-3535
Mailing Address - Street 1:1255 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-1577
Mailing Address - Country:US
Mailing Address - Phone:805-781-3535
Mailing Address - Fax:805-781-3538
Practice Address - Street 1:1255 KENDALL RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-1577
Practice Address - Country:US
Practice Address - Phone:805-781-3535
Practice Address - Fax:805-781-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36689251S00000X
CALCS 22859251S00000X
CAMFC 43246251S00000X
CAMFC 33553251S00000X
CAMFC 41603251S00000X
CAMFC 38416251S00000X
CAMFC 29668251S00000X
CALCS 22856251S00000X
CAMFC 30970251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4026OtherSHORT-DOYLE-MEDICAL PROVI