Provider Demographics
NPI:1003172073
Name:ESTHER'S GROUP HOME CORP.
Entity Type:Organization
Organization Name:ESTHER'S GROUP HOME CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-931-8023
Mailing Address - Street 1:20115 HIGHLAND LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2813
Mailing Address - Country:US
Mailing Address - Phone:305-931-8023
Mailing Address - Fax:305-792-7449
Practice Address - Street 1:20115 HIGHLAND LAKES BLVD
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2813
Practice Address - Country:US
Practice Address - Phone:305-931-8023
Practice Address - Fax:305-792-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11255DH320600000X
FL11255DH322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children