Provider Demographics
| NPI: | 1215582226 |
|---|---|
| Name: | BA GROUP OF MIAMI, LLC |
| Entity type: | Organization |
| Organization Name: | BA GROUP OF MIAMI, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | CHYKIMBERLY |
| Authorized Official - Middle Name: | QUANTEZ |
| Authorized Official - Last Name: | BULLARD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MS |
| Authorized Official - Phone: | 786-348-4771 |
| Mailing Address - Street 1: | 12555 BISCAYNE BLVD # 914 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NORTH MIAMI |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33181-2522 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 786-348-4771 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1160 NW 108TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | MIAMI |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33168-6032 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 786-348-4771 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-08-06 |
| Last Update Date: | 2019-08-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 174200000X | Other Service Providers | Meals | |
| No | 177F00000X | Other Service Providers | Lodging | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251E00000X | Agencies | Home Health | |
| No | 251J00000X | Agencies | Nursing Care | |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 305S00000X | Managed Care Organizations | Point of Service | |
| No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility | |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 347C00000X | Transportation Services | Private Vehicle | |
| No | 385H00000X | Respite Care Facility | Respite Care |
