Provider Demographics
NPI:1316243165
Name:SON & JOHNSON GROUP HOME,INC
Entity type:Organization
Organization Name:SON & JOHNSON GROUP HOME,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:CARLINE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-396-7240
Mailing Address - Street 1:6191 HONEYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6737
Mailing Address - Country:US
Mailing Address - Phone:561-393-7240
Mailing Address - Fax:561-964-9543
Practice Address - Street 1:6191 HONEYWOOD WAY
Practice Address - Street 2:
Practice Address - City:LAKEWORTH
Practice Address - State:FL
Practice Address - Zip Code:33463
Practice Address - Country:US
Practice Address - Phone:561-396-7240
Practice Address - Fax:561-964-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL691655496320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities