Provider Demographics
NPI:1417548249
Name:AURILIA'S PLACE A PLACE TO CALL HOME LLC
Entity type:Organization
Organization Name:AURILIA'S PLACE A PLACE TO CALL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AURILIA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:GRAY-GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MHC
Authorized Official - Phone:754-249-6359
Mailing Address - Street 1:2551 NW 103RD AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6805
Mailing Address - Country:US
Mailing Address - Phone:754-249-6359
Mailing Address - Fax:
Practice Address - Street 1:744 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7102
Practice Address - Country:US
Practice Address - Phone:754-249-6359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770047797Medicaid