Provider Demographics
NPI:1295183879
Name:LIVING HOPE GROUP HOME
Entity Type:Organization
Organization Name:LIVING HOPE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIORAL TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARENCIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-474-7545
Mailing Address - Street 1:4634 SW 164TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5198
Mailing Address - Country:US
Mailing Address - Phone:786-474-7545
Mailing Address - Fax:786-362-6128
Practice Address - Street 1:4634 SW 164TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:786-474-7545
Practice Address - Fax:786-362-6128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-24
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-01059103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty