Provider Demographics
NPI:1346401064
Name:A FAMILY FIRST COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:A FAMILY FIRST COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUBRINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-414-9676
Mailing Address - Street 1:2193 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 25
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4116
Mailing Address - Country:US
Mailing Address - Phone:770-414-9676
Mailing Address - Fax:770-414-8415
Practice Address - Street 1:2193 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 25
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4116
Practice Address - Country:US
Practice Address - Phone:770-414-9676
Practice Address - Fax:770-414-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA839321842AMedicaid