MEDICARE: KIARA COMMUNITY 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1982569174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIARA COMMUNITY GROUP HOME INC

Provider Business Mailing Address
First Line	:	9061 SW 212TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3867
Country	:	US
Telephone Number	:	305-244-3633
Fax Number	:	305-244-3633

Provider Business Practice Location Address
First Line	:	9061 SW 212TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3867
Country	:	US
Telephone Number	:	305-244-3633
Fax Number	:	305-244-3633

Authorized Official
Title or Position	:	OWNER
Name	:	MARYDUNIA CASTRO
Credential	:
Telephone Number	:	305-244-3633

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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