Provider Demographics
NPI:1972932119
Name:FAMILY CARE SERVICES LLC
Entity Type:Organization
Organization Name:FAMILY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-461-8036
Mailing Address - Street 1:6114 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2147
Mailing Address - Country:US
Mailing Address - Phone:414-461-8036
Mailing Address - Fax:
Practice Address - Street 1:6114 W CAPITOL DR
Practice Address - Street 2:306
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2147
Practice Address - Country:US
Practice Address - Phone:414-461-8036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100028479Medicaid