Provider Demographics
NPI:1487241386
Name:FAMILY GROUP HOME LLC
Entity type:Organization
Organization Name:FAMILY GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-665-9174
Mailing Address - Street 1:11010 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4444
Mailing Address - Country:US
Mailing Address - Phone:305-603-9603
Mailing Address - Fax:786-409-2052
Practice Address - Street 1:11010 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4444
Practice Address - Country:US
Practice Address - Phone:305-603-9603
Practice Address - Fax:786-409-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-25
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility