Provider Demographics
NPI:1457608093
Name:MY FAMILY HOME CARE LLC
Entity Type:Organization
Organization Name:MY FAMILY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-408-9027
Mailing Address - Street 1:3020 PICKETT RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6000
Mailing Address - Country:US
Mailing Address - Phone:919-408-9027
Mailing Address - Fax:
Practice Address - Street 1:3020 PICKETT RD
Practice Address - Street 2:SUITE 120
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6000
Practice Address - Country:US
Practice Address - Phone:919-408-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4557253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care