Provider Demographics
NPI:1760780753
Name:A GUARDIAN GROUP HOME
Entity Type:Organization
Organization Name:A GUARDIAN GROUP HOME
Other - Org Name:AGGHINC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-499-5580
Mailing Address - Street 1:9715 SW 73RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4625
Mailing Address - Country:US
Mailing Address - Phone:305-255-3731
Mailing Address - Fax:305-234-2039
Practice Address - Street 1:9715 SW 73RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4625
Practice Address - Country:US
Practice Address - Phone:305-255-3731
Practice Address - Fax:305-234-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11-658-GH320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities