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General NPI Number Information
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NPI Number | 1235019613
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Entity Type | Organization
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Legal Business Name | YOUR HOME GROUP HOME LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 331 FULTON ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3021
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Country | US
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Telephone | 321-295-1695
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Fax |
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Provider Business Mailing Address
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Address Line | 271 CHEROKEE HILL CT
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City | DELAND
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State | FL
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Zip | 32724-7827
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | CORINDA GOFF
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Credential | BS
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Telephone | 321-295-1695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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