Provider Demographics
NPI:1487135620
Name:EXTENDED FAMILY OF NORTH FLORIDA, LLC
Entity type:Organization
Organization Name:EXTENDED FAMILY OF NORTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:386-315-1260
Mailing Address - Street 1:PO BOX 350373
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-0373
Mailing Address - Country:US
Mailing Address - Phone:386-222-2791
Mailing Address - Fax:386-401-2467
Practice Address - Street 1:21 BENNETT LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8610
Practice Address - Country:US
Practice Address - Phone:386-315-1260
Practice Address - Fax:386-401-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-26
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty