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General NPI Number Information
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NPI Number | 1174322887
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Entity Type | Organization
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Legal Business Name | ROANDFAY GROUP HOME, LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1261 SW 46TH AVENUE, APT 2002
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City | POMPANO BEACH
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State | FL
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Zip | 33069
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Country | US
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Telephone | 315-447-0834
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 NW 33RD AVE STE 200
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-6398
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Country | US
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Telephone | 315-447-0834
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSHELL ROSS-EDWARDS
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Credential | RN
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Telephone | 315-447-0834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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