Healthcare Provider Details

I. General information

NPI: 1033043336
Provider Name (Legal Business Name): CHRISTMAS GROUP HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4537 DECATUR ST
MARIANNA FL
32446-3212
US

IV. Provider business mailing address

PO BOX 6353
MARIANNA FL
32447-6353
US

V. Phone/Fax

Practice location:
  • Phone: 850-557-7148
  • Fax:
Mailing address:
  • Phone: 850-557-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BOBBY CHRISTMAS JR.
Title or Position: OWNER/OPERATOR
Credential:
Phone: 850-557-7148