Provider Demographics
NPI:1952317117
Name:FAMILY CARE HOME PA
Entity Type:Organization
Organization Name:FAMILY CARE HOME PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HUSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-669-4505
Mailing Address - Street 1:3164 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:828-669-4505
Mailing Address - Fax:828-669-5112
Practice Address - Street 1:3164 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711
Practice Address - Country:US
Practice Address - Phone:828-669-4505
Practice Address - Fax:828-669-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00350207Q00000X
NC122566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339223Medicare ID - Type Unspecified