Provider Demographics
NPI:1861765638
Name:FAMILY CARE FIRST, INC.
Entity type:Organization
Organization Name:FAMILY CARE FIRST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:256-227-0571
Mailing Address - Street 1:1023 AL. HWY 13
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565
Mailing Address - Country:US
Mailing Address - Phone:205-486-5050
Mailing Address - Fax:205-486-5060
Practice Address - Street 1:1023 HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1638
Practice Address - Country:US
Practice Address - Phone:205-269-5036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY CARE FIRST, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-09
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
AL207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL164019Medicaid