Provider Demographics
NPI:1720967037
Name:FAMILY FIRST GROUP HOME LLC
Entity type:Organization
Organization Name:FAMILY FIRST GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-400-8646
Mailing Address - Street 1:5230 17TH AVE N FL 33710
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5102
Mailing Address - Country:US
Mailing Address - Phone:813-400-8646
Mailing Address - Fax:813-870-4000
Practice Address - Street 1:5230 17TH AVE N FL 33710
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5102
Practice Address - Country:US
Practice Address - Phone:813-400-8646
Practice Address - Fax:813-870-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities