Family Care at Home

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

FAMILY CARE AT HOME

Practice address

4334 122ND Cir NE
Blaine, MN 55449-2103

Phone

(615) 668-0500

NPI assigned

Jul 23, 2024

Organization subpart

No

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

Authorized official

Name

Clovis Gray Jr.

Title

Executive Director

Phone

(615) 668-0500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1407684285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4334 122ND CIR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554492103",
            "telephone_number": "615-668-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4334 122ND CIR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554492103",
            "telephone_number": "615-668-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE AT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "CLOVIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-668-0500",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fairview Clinics
• Fairview Express Care
• Fairview Express Care
• Fairview Health Services
• Fairview Pharmacy Services LLC
• Family First Chiropractic Center PC
• Family Home Care Services LLC
• Family Oral Surgery Specialists, PLC
• Hudeyfa Farah
• Ifrah Farah

• All providers in Blaine, MN
• Nursing Facility/Intermediate Care Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.