Healthcare Provider Details

I. General information

NPI: 1053856054
Provider Name (Legal Business Name): RASCON GROUP HOME, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 SW 55TH ST
MIAMI FL
33165-6913
US

IV. Provider business mailing address

10920 SW 55TH ST
MIAMI FL
33165-6913
US

V. Phone/Fax

Practice location:
  • Phone: 786-853-3082
  • Fax: 305-662-2549
Mailing address:
  • Phone: 786-853-3082
  • Fax: 305-662-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EREIDA BENITEZ
Title or Position: OWNER
Credential:
Phone: 786-853-3082