Provider Demographics
NPI:1386791325
Name:FAMILY HOME CARE INC
Entity type:Organization
Organization Name:FAMILY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BROOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-336-3920
Mailing Address - Street 1:519 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4133
Mailing Address - Country:US
Mailing Address - Phone:315-336-3920
Mailing Address - Fax:315-339-7270
Practice Address - Street 1:519 N MADISON ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4133
Practice Address - Country:US
Practice Address - Phone:315-336-3920
Practice Address - Fax:315-339-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X, 251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01168721Medicaid
NY01145784Medicaid