MEDICARE: ABC GROUP HOME CORP

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	251C00000X	Developmentally Disabled Services Day Training Agency

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	:	1932755014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC GROUP HOME CORP

Provider Business Mailing Address
First Line	:	10310 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4932
Country	:	US
Telephone Number	:	786-356-0630
Fax Number	:

Provider Business Practice Location Address
First Line	:	10310 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4932
Country	:	US
Telephone Number	:	786-356-0630
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIDICE ZURBANO
Credential	:
Telephone Number	:	786-356-0630

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	08/14/2019

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Directions to “ABC GROUP HOME CORP ” Practice Location

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