Provider Demographics
NPI:1396499752
Name:METAMORPHOSIS FOR LIFE, INC.
Entity type:Organization
Organization Name:METAMORPHOSIS FOR LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP HOME PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:H
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-345-7833
Mailing Address - Street 1:17130 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4303
Mailing Address - Country:US
Mailing Address - Phone:305-345-7833
Mailing Address - Fax:
Practice Address - Street 1:3100 NW 170TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4328
Practice Address - Country:US
Practice Address - Phone:305-310-8450
Practice Address - Fax:305-259-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health