Provider Demographics
NPI:1275762742
Name:FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-519-5593
Mailing Address - Street 1:1572 HIGHWAY 85 N STE 338
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7729
Mailing Address - Country:US
Mailing Address - Phone:678-519-5593
Mailing Address - Fax:678-519-5674
Practice Address - Street 1:1572 HIGHWAY 85 N STE 338
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7729
Practice Address - Country:US
Practice Address - Phone:678-519-5593
Practice Address - Fax:678-519-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129033AMedicaid
GA6716320001Medicare NSC