Provider Demographics
NPI:1396476198
Name:RUBEN SUAREZ GROUP HOME,INC
Entity type:Organization
Organization Name:RUBEN SUAREZ GROUP HOME,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-345-7974
Mailing Address - Street 1:17150 NW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3500
Mailing Address - Country:US
Mailing Address - Phone:305-345-7974
Mailing Address - Fax:
Practice Address - Street 1:17131 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3923
Practice Address - Country:US
Practice Address - Phone:305-620-4527
Practice Address - Fax:305-627-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities