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General NPI Number Information
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NPI Number | 1548143423
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Entity Type | Organization
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Legal Business Name | MARIGOLD GROUP HOME
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 5111 KIPP PL
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City | ORLANDO
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State | FL
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Zip | 32808-4530
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Country | US
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Telephone | 407-757-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 5111 KIPP PL
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City | ORLANDO
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State | FL
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Zip | 32808-4530
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Country | US
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Telephone | 407-757-6555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANESHIA M BRYANT
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Credential | RN
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Telephone | 407-757-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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