Provider Demographics
NPI:1497292205
Name:FAMILY FRIEND,LLC
Entity Type:Organization
Organization Name:FAMILY FRIEND,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STURDIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-609-4976
Mailing Address - Street 1:1504 23RD ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-2528
Mailing Address - Country:US
Mailing Address - Phone:662-609-4976
Mailing Address - Fax:662-223-3061
Practice Address - Street 1:1504 23RD ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-2528
Practice Address - Country:US
Practice Address - Phone:662-609-4976
Practice Address - Fax:662-223-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1059530251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care