Provider Demographics
NPI:1114482767
Name:JOANNS A PLACE OF REFUGE INC
Entity Type:Organization
Organization Name:JOANNS A PLACE OF REFUGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALINDA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-317-7079
Mailing Address - Street 1:885 NW 213TH LN UNIT 9-201
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2060
Mailing Address - Country:US
Mailing Address - Phone:786-317-7079
Mailing Address - Fax:
Practice Address - Street 1:15604 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6323
Practice Address - Country:US
Practice Address - Phone:786-317-7079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care