MEDICARE: REYNA GROUP HOMES FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1154207660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNA GROUP HOMES FOUNDATION INC

Provider Business Mailing Address
First Line	:	2101 N ANDREWS AVE
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-3946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 N ANDREWS AVE
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-3946
Country	:	US
Telephone Number	:	786-788-5080
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD CHARLEMON
Credential	:
Telephone Number	:	786-788-5080

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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