Provider Demographics
NPI:1225782774
Name:GLORIA'S GROUP HOME INC
Entity Type:Organization
Organization Name:GLORIA'S GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-205-6955
Mailing Address - Street 1:14255 SW 287TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1733
Mailing Address - Country:US
Mailing Address - Phone:305-246-4466
Mailing Address - Fax:305-247-7686
Practice Address - Street 1:14255 SW 287TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1733
Practice Address - Country:US
Practice Address - Phone:305-246-4466
Practice Address - Fax:305-247-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities