Healthcare Provider Details

I. General information

NPI: 1588241962
Provider Name (Legal Business Name): TOIRAK'S GROUP HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 NW 139TH ST
NORTH MIAMI FL
33168-4021
US

IV. Provider business mailing address

451 NW 139TH ST
NORTH MIAMI FL
33168-4021
US

V. Phone/Fax

Practice location:
  • Phone: 305-323-1986
  • Fax: 305-687-8649
Mailing address:
  • Phone: 305-323-1986
  • 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: JESUS CRUZ
Title or Position: VICE PRESIDENT/ADMINISTRATOR
Credential:
Phone: 305-323-1986