Provider Demographics
NPI:1174322887
Name:ROANDFAY GROUP HOME, LLC
Entity type:Organization
Organization Name:ROANDFAY GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-447-0834
Mailing Address - Street 1:5200 NW 33RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6398
Mailing Address - Country:US
Mailing Address - Phone:315-447-0834
Mailing Address - Fax:
Practice Address - Street 1:1261 SW 46TH AVENUE, APT 2002
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:315-447-0834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services