Provider Demographics
NPI:1366799629
Name:FAMILY HOME SERVICE, INC
Entity type:Organization
Organization Name:FAMILY HOME SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-455-1949
Mailing Address - Street 1:1040 W HURON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-8025
Mailing Address - Country:US
Mailing Address - Phone:312-455-1949
Mailing Address - Fax:312-455-1415
Practice Address - Street 1:1040 W HURON ST STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8025
Practice Address - Country:US
Practice Address - Phone:312-455-1949
Practice Address - Fax:312-455-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty