Provider Demographics
NPI:1376601179
Name:FAMILY FIRST HEALTH CARE CAPAC PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST HEALTH CARE CAPAC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DECARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-395-4840
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAPAC
Mailing Address - State:MI
Mailing Address - Zip Code:48014-3715
Mailing Address - Country:US
Mailing Address - Phone:810-395-4840
Mailing Address - Fax:810-395-7551
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAPAC
Practice Address - State:MI
Practice Address - Zip Code:48014-3715
Practice Address - Country:US
Practice Address - Phone:810-395-4840
Practice Address - Fax:810-395-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G411650OtherBLUE CARE NETWORK
MI080G411650OtherBLUE CROSS BLUE SHIELD
MI114735675Medicaid
MI114950369Medicaid