Healthcare Provider Details

I. General information

NPI: 1417027491
Provider Name (Legal Business Name): BAKER GROUP HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 NW 21ST COURT
MIAMI FL
33147-6961
US

IV. Provider business mailing address

6965 NW 21ST CT
MIAMI FL
33147-6961
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-4572
  • Fax: 305-693-6426
Mailing address:
  • Phone: 305-300-4572
  • Fax: 305-693-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number11-542-GH
License Number StateFL

VIII. Authorized Official

Name: MS. BRENDA BAKER
Title or Position: DIRECTOR
Credential:
Phone: 305-300-4572