Provider Demographics
NPI:1447525324
Name:FAMILY CARE HOMES, INC.
Entity type:Organization
Organization Name:FAMILY CARE HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:480-827-1575
Mailing Address - Street 1:1511 N GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3902
Mailing Address - Country:US
Mailing Address - Phone:480-827-1575
Mailing Address - Fax:480-890-9092
Practice Address - Street 1:1511 N GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-3902
Practice Address - Country:US
Practice Address - Phone:480-827-1575
Practice Address - Fax:480-890-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL0223H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ427486Medicaid