Provider Demographics
NPI:1366759490
Name:CUTLER BAY GROUP HOME
Entity type:Organization
Organization Name:CUTLER BAY GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:NAVARRO-CARTAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-278-2816
Mailing Address - Street 1:10471 SW 204TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1350
Mailing Address - Country:US
Mailing Address - Phone:305-278-2816
Mailing Address - Fax:
Practice Address - Street 1:10471 SW 204TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1350
Practice Address - Country:US
Practice Address - Phone:305-278-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000227200320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000227200Medicaid