Provider Demographics
NPI:1821134941
Name:MIAMI CEREBRAL PALSY RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:MIAMI CEREBRAL PALSY RESIDENTIAL SERVICES, INC.
Other - Org Name:80TH STREET FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-599-0899
Mailing Address - Street 1:11750 SW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4819
Mailing Address - Country:US
Mailing Address - Phone:305-274-5014
Mailing Address - Fax:305-274-7056
Practice Address - Street 1:11750 SW 80TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4819
Practice Address - Country:US
Practice Address - Phone:305-274-5014
Practice Address - Fax:305-274-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4052096315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities