Provider Demographics
NPI:1043362031
Name:CENTRAL FLORIDA GROUP HOMES LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-DSI MANAGEMENT (MGMT. CO)
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-645-3211
Mailing Address - Street 1:1890 STATE ROAD 436
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2285
Mailing Address - Country:US
Mailing Address - Phone:407-645-3211
Mailing Address - Fax:407-628-2853
Practice Address - Street 1:1890 STATE ROAD 436 STE 295
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2285
Practice Address - Country:US
Practice Address - Phone:321-280-7023
Practice Address - Fax:321-280-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7G262A320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680598196Medicaid