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General NPI Number Information
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NPI Number | 1225782774
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Entity Type | Organization
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Legal Business Name | GLORIA'S GROUP HOME INC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 14255 SW 287TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-1733
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Country | US
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Telephone | 305-246-4466
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Fax | 305-247-7686
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Provider Business Mailing Address
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Address Line | 14255 SW 287TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-1733
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Country | US
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Telephone | 305-246-4466
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Fax | 305-247-7686
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GLORIA E POLANCO
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Credential |
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Telephone | 786-205-6955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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