Healthcare Provider Details

I. General information

NPI: 1932291556
Provider Name (Legal Business Name): JFK GROUP HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 FARMINGTON CIR
WELLINGTON FL
33414-8923
US

IV. Provider business mailing address

1233 45TH ST STE A5
WEST PALM BEACH FL
33407-2161
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-9575
  • Fax: 561-795-6906
Mailing address:
  • Phone: 561-863-7055
  • Fax: 561-863-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number090752
License Number StateFL

VIII. Authorized Official

Name: MR. STUART R RUSSELL
Title or Position: MEMBER
Credential:
Phone: 561-863-7055