Provider Demographics
NPI:1821283474
Name:FAMILY HOME PHYSICIANS, LLC
Entity Type:Organization
Organization Name:FAMILY HOME PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INFORMATION TECHNOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-414-9990
Mailing Address - Street 1:801 W. ANN ARBOR TRAIL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1694
Mailing Address - Country:US
Mailing Address - Phone:734-414-9990
Mailing Address - Fax:775-258-1535
Practice Address - Street 1:3911 GOLF PARK LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3453
Practice Address - Country:US
Practice Address - Phone:941-758-0379
Practice Address - Fax:941-727-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93274174400000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty