Provider Demographics
NPI:1760188189
Name:FAMILY AFFAIR HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:FAMILY AFFAIR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:BRAYLON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-853-2220
Mailing Address - Street 1:1515 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-4513
Mailing Address - Country:US
Mailing Address - Phone:412-853-2208
Mailing Address - Fax:
Practice Address - Street 1:1515 GRANT ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-4513
Practice Address - Country:US
Practice Address - Phone:412-853-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104087934-0001Medicaid