Provider Demographics
NPI:1336437961
Name:FAMILY LIFE MATTERS, LLC
Entity type:Organization
Organization Name:FAMILY LIFE MATTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-631-3684
Mailing Address - Street 1:PO BOX 2649
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-631-3684
Mailing Address - Fax:907-707-1212
Practice Address - Street 1:16720 E MAUD RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-631-3684
Practice Address - Fax:907-707-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0858 AUTHORIZED ANP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0858Medicaid