Provider Demographics
NPI:1568003176
Name:FAMILY FIRST RESIDENTIAL HOME
Entity Type:Organization
Organization Name:FAMILY FIRST RESIDENTIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARLISHA
Authorized Official - Middle Name:RUTHIE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-797-2688
Mailing Address - Street 1:5389 N ANGUS ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7014
Mailing Address - Country:US
Mailing Address - Phone:559-797-2688
Mailing Address - Fax:
Practice Address - Street 1:5389 N ANGUS ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7014
Practice Address - Country:US
Practice Address - Phone:559-797-2688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home