Provider Demographics
NPI:1235327958
Name:TRUTH & LIFE GROUP HOME,INC.
Entity Type:Organization
Organization Name:TRUTH & LIFE GROUP HOME,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARONA
Authorized Official - Suffix:
Authorized Official - Credentials:OPERATOR
Authorized Official - Phone:305-698-9534
Mailing Address - Street 1:5900 W 9TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:305-824-3387
Practice Address - Street 1:5900 W 9TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2361
Practice Address - Country:US
Practice Address - Phone:305-698-9534
Practice Address - Fax:305-824-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL690727096320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690727096Medicaid