Provider Demographics
NPI:1184201576
Name:FAMILY HOME HEALTH LLC
Entity Type:Organization
Organization Name:FAMILY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:DWAIN
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-274-5974
Mailing Address - Street 1:1650 38TH ST STE 101E
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2623
Mailing Address - Country:US
Mailing Address - Phone:720-274-5974
Mailing Address - Fax:720-274-5977
Practice Address - Street 1:1650 38TH ST STE 101E
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2623
Practice Address - Country:US
Practice Address - Phone:720-274-5974
Practice Address - Fax:720-274-5977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HOME HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-24
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43831761Medicaid