Provider Demographics
NPI:1164608204
Name:MENIQUE, INC. GROUP HOME
Entity Type:Organization
Organization Name:MENIQUE, INC. GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, MA
Authorized Official - Phone:305-331-5070
Mailing Address - Street 1:15990 SW 110TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3680
Mailing Address - Country:US
Mailing Address - Phone:305-386-2649
Mailing Address - Fax:305-386-2649
Practice Address - Street 1:15990 SW 110TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3680
Practice Address - Country:US
Practice Address - Phone:305-386-2649
Practice Address - Fax:305-386-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities