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General NPI Number Information
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NPI Number | 1295183879
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Entity Type | Organization
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Legal Business Name | LIVING HOPE GROUP HOME
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 4634 SW 164TH CT
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City | MIAMI
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State | FL
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Zip | 33185
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Country | US
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Telephone | 786-474-7545
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Fax | 786-362-6128
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Provider Business Mailing Address
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Address Line | 4634 SW 164TH CT
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City | MIAMI
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State | FL
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Zip | 33185-5198
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Country | US
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Telephone | 786-474-7545
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Fax | 786-362-6128
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Authorized Official
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Title or Position | REGISTERED BEHAVIORAL TECHNICIAN
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Name | MR. JUAN M ARENCIBIA
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Credential |
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Telephone | 786-474-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-15-01059
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License Number State | FL
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