Provider Demographics
NPI:1376987339
Name:RIVERO GROUP HOMES INC
Entity Type:Organization
Organization Name:RIVERO GROUP HOMES INC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-849-5777
Mailing Address - Street 1:236 SW 28TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2322
Mailing Address - Country:US
Mailing Address - Phone:786-378-0909
Mailing Address - Fax:305-860-1151
Practice Address - Street 1:236 SW 28TH RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2322
Practice Address - Country:US
Practice Address - Phone:786-378-0909
Practice Address - Fax:305-860-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003015900Medicaid