MEDICARE: BURROUGHS' GROUP HOME, 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	171M00000X	Case Manager/Care Coordinator		FL

General Provider Information

NPI Number	:	1174703128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURROUGHS' GROUP HOME, INC.

Provider Business Mailing Address
First Line	:	3490 NW 200TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-1786
Country	:	US
Telephone Number	:	305-620-0777
Fax Number	:	305-627-6979

Provider Business Practice Location Address
First Line	:	3490 NW 200TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-1786
Country	:	US
Telephone Number	:	305-620-0777
Fax Number	:	305-627-6979

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MISS MYRTICE BURROUGHS
Credential	:
Telephone Number	:	305-620-0777

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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