Provider Demographics
NPI:1174911606
Name:FAMILY HOME CARE LLC
Entity type:Organization
Organization Name:FAMILY HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-755-4954
Mailing Address - Street 1:22820 E APPLEWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9514
Mailing Address - Country:US
Mailing Address - Phone:509-795-5501
Mailing Address - Fax:509-755-4974
Practice Address - Street 1:1716 N UNION RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4834
Practice Address - Country:US
Practice Address - Phone:509-473-4949
Practice Address - Fax:509-921-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60333309251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health