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General NPI Number Information
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NPI Number | 1942980099
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Entity Type | Organization
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Legal Business Name | REYNA GROUP HOME INC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 6960 RALEIGH ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2840
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Country | US
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Telephone | 954-599-7905
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Fax | 754-210-7583
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Provider Business Mailing Address
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Address Line | 5201 NW 33RD AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-6302
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Country | US
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Telephone | 954-599-7905
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Fax | 754-210-7583
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Authorized Official
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Title or Position | CEO
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Name | RICHARD CHARLEMON
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Credential |
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Telephone | 954-599-7905
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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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