# VICKSBURG FAMILY HOME CARE,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649023235
- **Authorized official:** MR. TERRY LYNN BARNES JR. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (269) 762-2092

## Contact information

- **Practice address:** 706 W PRAIRIE ST, VICKSBURG, MI 49097-1041
- **Practice address phone:** (269) 762-2092
- **Practice address fax:** (269) 315-5100
- **Mailing address:** 706 W PRAIRIE ST, VICKSBURG, MI 49097-1041
- **Mailing address phone:** (269) 762-2092
- **Mailing address fax:** (269) 315-5100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA0600X | Adult Day Care Clinic/Center | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | Yes |
| 385HR2065X | Child Physical Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 04/11/2024
- **Last updated:** 04/11/2024