Provider Demographics
NPI:1083231120
Name:V & V GROUP HOME, LLC
Entity Type:Organization
Organization Name:V & V GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZBERT DIEGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-218-8423
Mailing Address - Street 1:6442 MALTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7298
Mailing Address - Country:US
Mailing Address - Phone:786-218-8423
Mailing Address - Fax:
Practice Address - Street 1:6442 MALTON ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-7298
Practice Address - Country:US
Practice Address - Phone:786-218-8423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities