Provider Demographics
NPI:1649023235
Name:VICKSBURG FAMILY HOME CARE,LLC
Entity type:Organization
Organization Name:VICKSBURG FAMILY HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:269-762-2092
Mailing Address - Street 1:706 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-1041
Mailing Address - Country:US
Mailing Address - Phone:269-762-2092
Mailing Address - Fax:269-315-5100
Practice Address - Street 1:706 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-1041
Practice Address - Country:US
Practice Address - Phone:269-762-2092
Practice Address - Fax:269-315-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care