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General NPI Number Information
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NPI Number | 1407226004
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Entity Type | Organization
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Legal Business Name | J. R. HOME RANCH #1, INC.
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 20700 SW 136TH ST
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City | MIAMI
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State | FL
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Zip | 33196-1882
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Country | US
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Telephone | 305-255-6521
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Fax | 305-255-6521
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Provider Business Mailing Address
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Address Line | 20700 SW 136TH ST
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City | MIAMI
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State | FL
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Zip | 33196-1882
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Country | US
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Telephone | 305-255-6521
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Fax | 305-255-6521
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Authorized Official
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Title or Position | CEO
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Name | MRS. TANIA ROBLA
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Credential |
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Telephone | 305-807-8978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | FL
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