MEDICARE: GARCIA GROUP HOME 1

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1972968923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARCIA GROUP HOME 1

Provider Business Mailing Address
First Line	:	389 DE LEON DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5903
Country	:	US
Telephone Number	:	305-903-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	389 DE LEON DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5903
Country	:	US
Telephone Number	:	305-903-9006
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OSCAR GARCIA
Credential	:
Telephone Number	:	305-903-9006

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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