Provider Demographics
NPI:1174175509
Name:FAMILY LIFE CARE, INC.
Entity type:Organization
Organization Name:FAMILY LIFE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-579-1581
Mailing Address - Street 1:555 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2923
Mailing Address - Country:US
Mailing Address - Phone:904-579-1582
Mailing Address - Fax:904-375-1673
Practice Address - Street 1:216 S APOPKA AVE STE B
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4845
Practice Address - Country:US
Practice Address - Phone:352-344-5228
Practice Address - Fax:352-344-0894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY LIFE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-16
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009971800Medicaid
FL30211324OtherNURSE REGISTRY LICENSE