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General NPI Number Information
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NPI Number | 1174703128
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Entity Type | Organization
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Legal Business Name | BURROUGHS' GROUP HOME, INC.
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 3490 NW 200TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1786
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Country | US
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Telephone | 305-620-0777
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Fax | 305-627-6979
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Provider Business Mailing Address
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Address Line | 3490 NW 200TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1786
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Country | US
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Telephone | 305-620-0777
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Fax | 305-627-6979
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MISS MYRTICE BURROUGHS
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Credential |
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Telephone | 305-620-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | FL
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