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General NPI Number Information
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NPI Number | 1689300568
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Entity Type | Organization
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Legal Business Name | MVP GROUP HOME I LLC
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 266 N TWIN MAPLE RD
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-8398
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Country | US
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Telephone | 904-669-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 701 SAN JOSE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6551
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Country | US
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Telephone | 904-669-8446
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE CASON
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Credential |
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Telephone | 904-669-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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