Provider Demographics
NPI:1700658416
Name:FAM 4 LIFE SERVICES
Entity Type:Organization
Organization Name:FAM 4 LIFE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:RPSSS
Authorized Official - Phone:804-503-4857
Mailing Address - Street 1:24308 DRIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-8836
Mailing Address - Country:US
Mailing Address - Phone:804-503-4857
Mailing Address - Fax:
Practice Address - Street 1:24308 DRIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-8836
Practice Address - Country:US
Practice Address - Phone:804-503-4857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management