MEDICARE: GLADY'S 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	689362796	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912167511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADY'S GROUP HOME INC

Provider Business Mailing Address
First Line	:	213 SW LANGFIELD AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-4926
Country	:	US
Telephone Number	:	772-343-8472
Fax Number	:	772-879-6737

Provider Business Practice Location Address
First Line	:	213 SW LANGFIELD AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4926
Country	:	US
Telephone Number	:	772-343-8472
Fax Number	:	772-879-6737

Authorized Official
Title or Position	:	CEO
Name	:	MRS. YAMARIS TATUM
Credential	:
Telephone Number	:	772-343-8472

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

Similar Medicare Providers

1538311303 — PRICILLA'S LOVING CARE CORP
Practice Location Address:

213 SW LANGFIELD AVE
PORT ST LUCIE, FL
34984-4926

Practice Phone: 772-370-7251
Practice Fax: 772-879-6737

1306701933 — MARIDELYS NASCO VERDE
Practice Location Address:

8949 SAINT REGIS LN
PORT RICHEY, FL
34668-4926

Practice Phone: 727-377-8574
Practice Fax:

1477726230 — GAIL B SWEET LPC
Practice Location Address:

4926 REBER PL , 3309 S. KINGSHIGHWAY BLVD.
SAINT LOUIS, MO
63139-1028

Practice Phone: 314-534-9350
Practice Fax: 314-533-6047

1205257573 — MARC EDMOND SYLVESTRE D.C.
Practice Location Address:

2220 HIGHWAY 10
SAINT PAUL, MN
55112-4926

Practice Phone: 763-398-7770
Practice Fax:

1023805561 — HALEY MICHAEL ANDERSON
Practice Location Address:

156 44TH AVE NE
SAINT PETERSBURG, FL
33703-4926

Practice Phone: 727-482-4360
Practice Fax:

1679438394 — VIOLETTE AUGUSTIN
Practice Location Address:

2094 SW BRISBANE ST
PORT SAINT LUCIE, FL
34984-4404

Practice Phone: 678-334-3152
Practice Fax:

Directions to “GLADY'S GROUP HOME INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.