Provider Demographics
NPI:1942980099
Name:REYNA GROUP HOME INC
Entity Type:Organization
Organization Name:REYNA GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLEMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-599-7905
Mailing Address - Street 1:5201 NW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6302
Mailing Address - Country:US
Mailing Address - Phone:954-599-7905
Mailing Address - Fax:754-210-7583
Practice Address - Street 1:6960 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2840
Practice Address - Country:US
Practice Address - Phone:954-599-7905
Practice Address - Fax:754-210-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities