Provider Demographics
NPI:1780203018
Name:FAMILY FIRST DEVELOPMENTAL GROUP HOME INC.
Entity Type:Organization
Organization Name:FAMILY FIRST DEVELOPMENTAL GROUP HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-910-8235
Mailing Address - Street 1:22125 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2840
Mailing Address - Country:US
Mailing Address - Phone:305-910-8235
Mailing Address - Fax:
Practice Address - Street 1:10030 NICARAGUA DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2337
Practice Address - Country:US
Practice Address - Phone:305-910-8235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL784041OtherATN