Provider Demographics
NPI:1619520822
Name:M&J MILAGROS DEL CIELO #1 GROUP HOME , CORP
Entity Type:Organization
Organization Name:M&J MILAGROS DEL CIELO #1 GROUP HOME , CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:786-691-8335
Mailing Address - Street 1:9830 SW 12TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2912
Mailing Address - Country:US
Mailing Address - Phone:786-447-3460
Mailing Address - Fax:
Practice Address - Street 1:9830 SW 12TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2912
Practice Address - Country:US
Practice Address - Phone:786-447-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities