Provider Demographics
NPI:1790376093
Name:FAMILY MOBILE HEALTH LLC
Entity Type:Organization
Organization Name:FAMILY MOBILE HEALTH LLC
Other - Org Name:FAMILY MOBILE HEALTH, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-834-0682
Mailing Address - Street 1:4321 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1482
Mailing Address - Country:US
Mailing Address - Phone:270-834-0682
Mailing Address - Fax:
Practice Address - Street 1:4321 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1482
Practice Address - Country:US
Practice Address - Phone:270-834-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care