Provider Demographics
NPI: | 1558771162 |
---|---|
Name: | FAMILY TO FAMILY HOME CARE LLC |
Entity Type: | Organization |
Organization Name: | FAMILY TO FAMILY HOME CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | GREG |
Authorized Official - Middle Name: | MARTIN |
Authorized Official - Last Name: | GUTHRIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 262-455-1221 |
Mailing Address - Street 1: | 8330 64TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | KENOSHA |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53142-7578 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-657-5132 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8330 64TH ST |
Practice Address - Street 2: | |
Practice Address - City: | KENOSHA |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53142-7578 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-657-5132 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-05-05 |
Last Update Date: | 2014-05-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 253Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 100034444 | Medicaid |