Organization
FAMILY CARE AT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLOVIS GRAY JR. (EXECUTIVE DIRECTOR)
(615) 668-0500
Entity
Organization
Contact information
Practice address
4334 122ND CIR NE, BLAINE, MN 55449-2103
(615) 668-0500
Mailing address
4334 122ND CIR NE, BLAINE, MN 55449-2103
(615) 668-0500
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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