Provider Demographics
NPI:1033413133
Name:AMIGOS GROUP HOMES, CORP
Entity Type:Organization
Organization Name:AMIGOS GROUP HOMES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISMITRADOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-536-2381
Mailing Address - Street 1:2735 SW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2634
Mailing Address - Country:US
Mailing Address - Phone:305-225-7119
Mailing Address - Fax:305-225-1289
Practice Address - Street 1:2735 SW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2634
Practice Address - Country:US
Practice Address - Phone:305-225-7119
Practice Address - Fax:305-225-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11120310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility