Healthcare Provider Details

I. General information

NPI: 1023939485
Provider Name (Legal Business Name): AMAZING GROUP HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 SW 30TH ST
MIAMI FL
33175-2606
US

IV. Provider business mailing address

12610 SW 30TH ST
MIAMI FL
33175-2606
US

V. Phone/Fax

Practice location:
  • Phone: 786-362-4767
  • Fax: 305-603-8727
Mailing address:
  • Phone: 786-362-4767
  • Fax: 305-603-8727

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: GLADYS JIMENEZ
Title or Position: OWNER
Credential:
Phone: 786-362-4767