Healthcare Provider Details

I. General information

NPI: 1164391769
Provider Name (Legal Business Name): FMP GROUP HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 SE 15TH TER
CAPE CORAL FL
33990-1971
US

IV. Provider business mailing address

PO BOX 557384
MIAMI FL
33255-7384
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-2977
  • Fax:
Mailing address:
  • Phone: 786-444-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CARLOS REVILLA
Title or Position: OWNER
Credential:
Phone: 786-444-2977