Provider Demographics
NPI:1295930089
Name:FAMILY HEALTHCARE, LLC
Entity type:Organization
Organization Name:FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-0772
Mailing Address - Street 1:1321 MCARTHUR ST STE A
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2425
Mailing Address - Country:US
Mailing Address - Phone:931-728-0772
Mailing Address - Fax:931-728-0444
Practice Address - Street 1:1321 MCARTHUR ST STE A
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2425
Practice Address - Country:US
Practice Address - Phone:931-728-0772
Practice Address - Fax:931-728-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5896261QP2300X
TNDO1634261QP2300X
TNAPN6245261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709474Medicare Oscar/Certification