Provider Demographics
NPI:1861041428
Name:DAVIS FAMILY HOME CARE LLC
Entity Type:Organization
Organization Name:DAVIS FAMILY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANIECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-851-6745
Mailing Address - Street 1:133 BURKS LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-8328
Mailing Address - Country:US
Mailing Address - Phone:850-851-6745
Mailing Address - Fax:850-656-1747
Practice Address - Street 1:2957 CAPITAL PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3450
Practice Address - Country:US
Practice Address - Phone:850-851-6745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty