Provider Demographics
NPI:1346377496
Name:FAMILY HOME LIFE, INC
Entity Type:Organization
Organization Name:FAMILY HOME LIFE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-533-9200
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0066
Mailing Address - Country:US
Mailing Address - Phone:252-533-9200
Mailing Address - Fax:252-533-9207
Practice Address - Street 1:946 W ANDREWS AVE
Practice Address - Street 2:SUITE X
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2500
Practice Address - Country:US
Practice Address - Phone:252-436-0021
Practice Address - Fax:252-436-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management