NPIMap

Organization Active NPI

Family Life Care Inc

  • Home Health Agency
  • Orange Park, FL
National Provider Identifier
1295388213
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
FAMILY LIFE CARE INC
Practice address
555 Wells Rd
Orange Park, FL 32073-2923
Phone
(904) 529-7072
Fax
(904) 529-7056
NPI assigned
Jul 18, 2019
Last updated
Aug 31, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY LIFE CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David McMullen
Title
Ceo
Phone
(904) 579-1581

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

555 Wells Rd
Orange Park, FL 32073-2923

Mailing address

555 Wells Rd
Orange Park, FL 32073-2923
Phone (904) 529-7072

Other identifiers 1

IdentifierTypeStateIssuer
299994651OtherFLHOME HEALTH AGENCY LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200218001153 FL Part A Provider - Home Health Agency 4587757703 Practice locations: Orange Park, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295388213. Details of each certification follow.

Home health agency certification: CCN 687045

Legal name
FAMILY LIFE CARE, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 5, 2020
Last certification
Jun 5, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Oct 16, 2000 in FL
Enrollment address
555 Wells Rd
Orange Park, FL 32073-2923

Care Compare: Home health agency

Medicare Care Compare
Listed as
Family Life Care IncCCN 687045 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Jun 5, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Family Life Care Inc5 organizations share this tax ID, including this one
Part of
Family Life Care Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

205 Howard St W
Live Oak, FL 32064
Phone (386) 364-5515

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brenda Valdez Individual 5% Or Greater Direct Ownership InterestRetired Oct 16, 2000 8%
David McMullen Individual Corporate OfficerPresident/Ceo Aug 29, 2019 88.8%
W-2 Managing EmployeePresident/Ceo Oct 16, 2000 88.8%
Operational/Managerial ControlPresident/Ceo Oct 16, 2000 88.8%

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1295388213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 WELLS RD",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732923",
            "telephone_number": "904-529-7072",
            "fax_number": "904-529-7056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 WELLS RD",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732923",
            "telephone_number": "904-529-7072",
            "fax_number": "904-529-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LIFE CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY LIFE CARE, INC.",
        "enumeration_date": "2019-07-18",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "MCMULLEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-579-1581"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH AGENCY LICENSE",
            "identifier": "299994651",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.