Provider Demographics
NPI:1093032203
Name:FRIENDS AND FAMILY ACTIVITY CENTER
Entity Type:Organization
Organization Name:FRIENDS AND FAMILY ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-986-1207
Mailing Address - Street 1:196 LOGSTON LN
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2114
Mailing Address - Country:US
Mailing Address - Phone:859-986-1207
Mailing Address - Fax:859-985-5463
Practice Address - Street 1:196 LOGSTON LN
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2114
Practice Address - Country:US
Practice Address - Phone:859-986-1207
Practice Address - Fax:859-985-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750177251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care