Provider Demographics
NPI:1952476707
Name:FAMILY HOME CARE, INC.
Entity Type:Organization
Organization Name:FAMILY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-423-6779
Mailing Address - Street 1:1105 BATTLEGROUND DRIVE
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852
Mailing Address - Country:US
Mailing Address - Phone:662-423-6779
Mailing Address - Fax:662-423-6464
Practice Address - Street 1:1105 BATTLEGROUND DRIVE
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852
Practice Address - Country:US
Practice Address - Phone:662-423-6779
Practice Address - Fax:662-423-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL114332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000006584Medicaid
TN3554339Medicaid
AL000056058Medicaid
MS00040186Medicaid
AL3554339Medicaid
MS00040186Medicaid