Provider Demographics
NPI:1437010915
Name:FAMILY FRIENDLY CARE HOME LLC
Entity type:Organization
Organization Name:FAMILY FRIENDLY CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-272-7515
Mailing Address - Street 1:3784 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3407
Mailing Address - Country:US
Mailing Address - Phone:702-586-0710
Mailing Address - Fax:702-586-0710
Practice Address - Street 1:3784 EDISON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3407
Practice Address - Country:US
Practice Address - Phone:702-586-0710
Practice Address - Fax:702-586-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578264685Medicaid