Provider Demographics
NPI:1396215984
Name:VICKSBURG FAMILY HOME CARE,LLC
Entity Type:Organization
Organization Name:VICKSBURG FAMILY HOME CARE,LLC
Other - Org Name:VICKSBURG FAMILY HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:269-475-5211
Mailing Address - Street 1:706 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097
Mailing Address - Country:US
Mailing Address - Phone:269-475-5211
Mailing Address - Fax:269-315-5100
Practice Address - Street 1:706 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-4909
Practice Address - Country:US
Practice Address - Phone:269-475-5211
Practice Address - Fax:269-315-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253J00000XAgenciesFoster Care Agency
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities