Provider Demographics
NPI:1811254899
Name:FAMILY HOME CARE GROUP, LLC
Entity type:Organization
Organization Name:FAMILY HOME CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-401-9146
Mailing Address - Street 1:622 E WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2966
Mailing Address - Country:US
Mailing Address - Phone:407-401-9146
Mailing Address - Fax:407-517-4860
Practice Address - Street 1:622 E WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2966
Practice Address - Country:US
Practice Address - Phone:407-401-9146
Practice Address - Fax:407-517-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993988251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299993988OtherAGENCY FOR HEALTH CARE ADMINISTRATION