Provider Demographics
NPI:1265015929
Name:FAMILY ADULT SITTING SERVICES, (FASS),LLC
Entity Type:Organization
Organization Name:FAMILY ADULT SITTING SERVICES, (FASS),LLC
Other - Org Name:FASS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WOULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-358-6175
Mailing Address - Street 1:2319 S HIGHWAY 77 UNIT 1824
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-7773
Mailing Address - Country:US
Mailing Address - Phone:850-358-6175
Mailing Address - Fax:
Practice Address - Street 1:112 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-358-6175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care