Healthcare Provider Details

I. General information

NPI: 1689972747
Provider Name (Legal Business Name): EMBRACE GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 NE 22ND AVE
GAINESVILLE FL
32609-3878
US

IV. Provider business mailing address

1029 NE 22ND AVE
GAINESVILLE FL
32609-3878
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-8198
  • Fax:
Mailing address:
  • Phone: 352-336-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. AMANDA VINSON
Title or Position: OWNER
Credential:
Phone: 352-215-9401