Provider Demographics
NPI:1114915295
Name:FAMILY LIFE CARE, INC.
Entity Type:Organization
Organization Name:FAMILY LIFE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-579-1581
Mailing Address - Street 1:555 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2923
Mailing Address - Country:US
Mailing Address - Phone:904-579-1581
Mailing Address - Fax:
Practice Address - Street 1:4061 NW 43RD ST STE 10
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4538
Practice Address - Country:US
Practice Address - Phone:352-692-2899
Practice Address - Fax:352-374-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211029OtherNURSE REGISTRY
FL009653800Medicaid