Provider Demographics
NPI:1972906386
Name:DYNAMIC FAMILY CARE CENTER
Entity type:Organization
Organization Name:DYNAMIC FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEESHAUN
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-343-1682
Mailing Address - Street 1:1804 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-2922
Mailing Address - Country:US
Mailing Address - Phone:731-784-1373
Mailing Address - Fax:731-784-1375
Practice Address - Street 1:1804 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-2922
Practice Address - Country:US
Practice Address - Phone:731-784-1373
Practice Address - Fax:731-784-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care