Provider Demographics
NPI:1700039658
Name:FRIENDLY GROUP HOME INC.
Entity Type:Organization
Organization Name:FRIENDLY GROUP HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CARMELLE
Authorized Official - Last Name:LOUISSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-200-4915
Mailing Address - Street 1:530 SW 198 TERRACE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029
Mailing Address - Country:US
Mailing Address - Phone:786-200-4915
Mailing Address - Fax:
Practice Address - Street 1:2602 50TH STREET WEST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971
Practice Address - Country:US
Practice Address - Phone:239-368-2452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL089346251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693681496Medicaid