Provider Demographics
NPI:1558778605
Name:FAMILY LIFE CARE SERVICES
Entity Type:Organization
Organization Name:FAMILY LIFE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:TORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-779-1068
Mailing Address - Street 1:17680 NW 78TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3667
Mailing Address - Country:US
Mailing Address - Phone:305-779-1068
Mailing Address - Fax:305-779-1067
Practice Address - Street 1:17680 NW 78TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3667
Practice Address - Country:US
Practice Address - Phone:305-779-1068
Practice Address - Fax:305-779-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010923900Medicaid
FL007211400Medicaid