Provider Demographics
NPI:1578292512
Name:FAMILIAR FACE SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILIAR FACE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-864-4788
Mailing Address - Street 1:4225 W 86TH ST STE 1001A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1786
Mailing Address - Country:US
Mailing Address - Phone:317-864-4788
Mailing Address - Fax:
Practice Address - Street 1:4225 W 86TH ST STE 1001A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1786
Practice Address - Country:US
Practice Address - Phone:317-864-4788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care