Provider Demographics
NPI:1346239332
Name:FAMILY FOCUS INFUSION LLC
Entity Type:Organization
Organization Name:FAMILY FOCUS INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-855-0040
Mailing Address - Street 1:4417 BEACH BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4728
Mailing Address - Country:US
Mailing Address - Phone:904-855-0040
Mailing Address - Fax:904-855-0072
Practice Address - Street 1:4417 BEACH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4728
Practice Address - Country:US
Practice Address - Phone:904-855-0040
Practice Address - Fax:904-855-0072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FOCUS INFUSION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-21
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 26357183500000X, 1835N1003X
FLPH 13657332BP3500X, 3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Multi-Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103302601Medicaid
FL103302602Medicaid
FL103302600Medicaid
FL103302602Medicaid