Family Affair Care, LLC

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

Legal business name

FAMILY AFFAIR CARE, LLC

Practice address

343 Chamborley Dr
Reisterstown, MD 21136-6151

Phone

(443) 418-4254

NPI assigned

May 20, 2021

Last updated

Oct 2, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rebecca Yvette Jackson, MASTER IN NURSINGNPI 1649876749

Title

Nurse Practitioner

Phone

(443) 418-4254

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Tax ID family

Family Affair Care Limited Liabilit2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Family Affair Care, LLC

  • Primary Care Clinic/Center
  • Towson, MD
  • NPI 1114729472
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebecca Yvette Jackson, NP

  • Family Nurse Practitioner
  • Baltimore, MD
  • NPI 1649876749
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633132800000",
    "number": "1427623750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 CHAMBORLEY DR",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211366151",
            "telephone_number": "443-418-4254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 CHAMBORLEY DR",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211366151",
            "telephone_number": "443-418-4254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY AFFAIR CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-10-02",
        "certification_date": "2021-10-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "YVETTE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "443-418-4254",
        "authorized_official_credential": "MASTER IN NURSING"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Registered Nurse in Reisterstown, MD
• Providers in Reisterstown, MD by specialty
• General Practice Registered Nurse in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.