Healthcare Provider Details

I. General information

NPI: 1790611739
Provider Name (Legal Business Name): J & J HOME & COMMUNITY SUPPORT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SW 137TH AVE STE 225
MIAMI FL
33175-6332
US

IV. Provider business mailing address

2450 SW 137TH AVE STE 225
MIAMI FL
33175-6332
US

V. Phone/Fax

Practice location:
  • Phone: 786-409-2722
  • Fax:
Mailing address:
  • Phone: 786-409-2722
  • Fax:

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: JORGE L GONZALEZ
Title or Position: CEO
Credential:
Phone: 786-409-2722