Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Rural Health |
261QR1300X | B4[14] | Rural Health Clinic | |
Clinical |
1041C0700X | 80 | Licensed Clinical Social Worker | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1780924456 |
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| LBN Legal business name | FAMILY CARE CLINIC LLC | ||||||||||||
| Authorized official | THERESA HILL - (OWNER) | ||||||||||||
| Entity | Organization | ||||||||||||
| Organization subpart 1 | No | ||||||||||||
| Enumeration date | 02/18/2013 | ||||||||||||
| Last updated | 01/15/2021 - About 5 years ago | ||||||||||||
| Identifiers |
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