Provider Demographics
NPI:1396024527
Name:FAMILY CARE LIVING CENTER
Entity Type:Organization
Organization Name:FAMILY CARE LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-379-7828
Mailing Address - Street 1:11766 GLOVER ST
Mailing Address - Street 2:
Mailing Address - City:AXIS
Mailing Address - State:AL
Mailing Address - Zip Code:36505-4358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11780 GLOVER ST
Practice Address - Street 2:
Practice Address - City:AXIS
Practice Address - State:AL
Practice Address - Zip Code:36505-4358
Practice Address - Country:US
Practice Address - Phone:251-379-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities