Provider Demographics
NPI:1194861690
Name:GIFTED HEALTH GROUP, INC.
Entity Type:Organization
Organization Name:GIFTED HEALTH GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JEAN BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-201-1951
Mailing Address - Street 1:111 NW 183RD ST STE 414
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4540
Mailing Address - Country:US
Mailing Address - Phone:305-405-6553
Mailing Address - Fax:305-405-6283
Practice Address - Street 1:111 NW 183RD ST STE 414
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4540
Practice Address - Country:US
Practice Address - Phone:305-405-6553
Practice Address - Fax:305-405-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherMEDICAID WAIVER