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General NPI Number Information
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NPI Number | 1417027491
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Entity Type | Organization
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Legal Business Name | BAKER GROUP HOME, INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6965 NW 21ST COURT
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City | MIAMI
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State | FL
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Zip | 33147-6961
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Country | US
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Telephone | 305-300-4572
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Fax | 305-693-6426
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Provider Business Mailing Address
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Address Line | 6965 NW 21ST CT
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City | MIAMI
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State | FL
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Zip | 33147-6961
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Country | US
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Telephone | 305-300-4572
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Fax | 305-693-6426
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BRENDA BAKER
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Credential |
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Telephone | 305-300-4572
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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 | 11-542-GH
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License Number State | FL
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