Provider Demographics
NPI:1487883914
Name:FAMILY FUSION SERVICES LLC
Entity type:Organization
Organization Name:FAMILY FUSION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:
Authorized Official - Last Name:P
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-934-4202
Mailing Address - Street 1:1373 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3423
Mailing Address - Country:US
Mailing Address - Phone:770-934-4202
Mailing Address - Fax:404-684-6001
Practice Address - Street 1:1373 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3423
Practice Address - Country:US
Practice Address - Phone:770-934-4202
Practice Address - Fax:404-684-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA913294606AMedicaid