Provider Demographics
NPI:1740250133
Name:FAMILY HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:FAMILY HOME HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:1200 BATH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2659
Practice Address - Country:US
Practice Address - Phone:606-324-2491
Practice Address - Fax:606-324-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150164251B00000X, 251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100163100Medicaid
KY000000054994OtherBLUE CROSS PROVIDER ID
KY7100163050Medicaid
KY1166978OtherCHA HEALTH PROVIDER ID
KY34003103Medicaid
KY42003103Medicaid
OH2093452Medicaid
KY7100163080Medicaid
KY45344280Medicaid
KY7100163080Medicaid
KY187302Medicare Oscar/Certification