Provider Demographics
NPI:1053823252
Name:CONTRACTORS GROUP
Entity Type:Organization
Organization Name:CONTRACTORS GROUP
Other - Org Name:AUTISM HOME HEALT HMOMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-924-5773
Mailing Address - Street 1:926 SE BELFAST AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3914
Mailing Address - Country:US
Mailing Address - Phone:772-924-5773
Mailing Address - Fax:772-264-7865
Practice Address - Street 1:926 SE BELFAST AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3914
Practice Address - Country:US
Practice Address - Phone:772-924-5773
Practice Address - Fax:772-264-7865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G17000115761
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-27
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688745Medicaid