Provider Demographics
NPI:1689441255
Name:FAMILY CARE CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENGAGEMENT & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-540-2100
Mailing Address - Street 1:2860 S CIRCLE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4195
Mailing Address - Country:US
Mailing Address - Phone:719-540-2100
Mailing Address - Fax:
Practice Address - Street 1:4300 W CYPRESS ST STE 825
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4253
Practice Address - Country:US
Practice Address - Phone:719-540-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)