Provider Demographics
NPI:1851944847
Name:FAMILY LIFE CARE, INC.
Entity Type:Organization
Organization Name:FAMILY LIFE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-579-1581
Mailing Address - Street 1:555 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2923
Mailing Address - Country:US
Mailing Address - Phone:904-579-1581
Mailing Address - Fax:904-375-1673
Practice Address - Street 1:406 OHIO AVE S
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3218
Practice Address - Country:US
Practice Address - Phone:386-364-5515
Practice Address - Fax:386-364-5648
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY LIFE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-19
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680609100Medicaid
FL30211927OtherNURSE REGISTRY LICENSE