MEDICARE: RAYMOND'S GROUP HOME

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	320700000X	Physical Disabilities Residential Treatment Facility	1025746H	FL

General Provider Information

NPI Number	:	1588921290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYMOND'S GROUP HOME

Provider Business Mailing Address
First Line	:	8150 SW 6TH ST
Second Line	:
City	:	N LAUDERDALE
State	:	FL
Zip	:	33068-2014
Country	:	US
Telephone Number	:	954-549-0948
Fax Number	:	786-362-6971

Provider Business Practice Location Address
First Line	:	8150 SW 6TH ST
Second Line	:
City	:	N LAUDERDALE
State	:	FL
Zip	:	33068-2014
Country	:	US
Telephone Number	:	954-549-0948
Fax Number	:	786-362-6971

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAISY GRACIANO
Credential	:	HEALTH EDUCATER
Telephone Number	:	954-549-0948

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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Directions to “RAYMOND'S GROUP HOME ” Practice Location

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