Provider Demographics
NPI:1801221627
Name:FAMILY LIFE, LLC
Entity Type:Organization
Organization Name:FAMILY LIFE, LLC
Other - Org Name:FAMILY LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-429-1511
Mailing Address - Street 1:422 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4233
Mailing Address - Country:US
Mailing Address - Phone:208-442-8200
Mailing Address - Fax:208-442-1418
Practice Address - Street 1:422 11TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4233
Practice Address - Country:US
Practice Address - Phone:208-442-8200
Practice Address - Fax:208-442-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-1059311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)