MEDICARE: STEP GROUP HOME

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1598610578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP GROUP HOME

Provider Business Mailing Address
First Line	:	2940 JUPITER BLVD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4019
Country	:	US
Telephone Number	:	321-480-4052
Fax Number	:	321-821-1997

Provider Business Practice Location Address
First Line	:	951 COQUINA ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4518
Country	:	US
Telephone Number	:	321-480-4052
Fax Number	:	321-821-1997

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TARA DEMETRIA JOHNSON
Credential	:
Telephone Number	:	321-480-4052

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “STEP GROUP HOME ” Practice Location

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