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General NPI Number Information
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NPI Number | 1841696929
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Entity Type | Organization
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Legal Business Name | DREAM TEAM GROUP HOME, INC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 3653 NW 4TH TER
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City | MIAMI
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State | FL
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Zip | 33125-4073
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Country | US
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Telephone | 305-609-1258
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Fax | 866-490-1272
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Provider Business Mailing Address
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Address Line | 3653 NW 4TH TER
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City | MIAMI
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State | FL
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Zip | 33125-4073
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Country | US
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Telephone | 305-609-1258
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Fax | 866-490-1272
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Authorized Official
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Title or Position | OWNER AND DIRECTOR
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Name | MISS CYNTHIA GAY
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Credential |
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Telephone | 305-609-1258
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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 | 11-954-GH
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License Number State | FL
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