Provider Demographics
NPI:1104182401
Name:RX FAMILY HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:RX FAMILY HOME CARE SERVICES, LLC
Other - Org Name:RX FAMILY HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-326-0610
Mailing Address - Street 1:306 JAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5385
Mailing Address - Country:US
Mailing Address - Phone:810-326-0610
Mailing Address - Fax:810-289-3183
Practice Address - Street 1:306 JAY ST STE 1
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5385
Practice Address - Country:US
Practice Address - Phone:810-326-0610
Practice Address - Fax:810-289-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629349758OtherHUMANA AT HOME
MI1629349758Medicaid