Provider Demographics
NPI:1851750558
Name:FREIRE'S GROUP APD CARE
Entity Type:Organization
Organization Name:FREIRE'S GROUP APD CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASULTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-546-0105
Mailing Address - Street 1:12900 SW 25TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1850
Mailing Address - Country:US
Mailing Address - Phone:305-225-7669
Mailing Address - Fax:
Practice Address - Street 1:12900 SW 25TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-1850
Practice Address - Country:US
Practice Address - Phone:305-225-7669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11-834-GH320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities