Provider Demographics
NPI:1588921290
Name:RAYMOND'S GROUP HOME
Entity type:Organization
Organization Name:RAYMOND'S GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIANO
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH EDUCATER
Authorized Official - Phone:954-549-0948
Mailing Address - Street 1:8150 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2014
Mailing Address - Country:US
Mailing Address - Phone:954-549-0948
Mailing Address - Fax:786-362-6971
Practice Address - Street 1:8150 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:N LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2014
Practice Address - Country:US
Practice Address - Phone:954-549-0948
Practice Address - Fax:786-362-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1025746H320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities