Provider Demographics
NPI:1962665208
Name:RITA MARIA GROUP HOME, INC.
Entity Type:Organization
Organization Name:RITA MARIA GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-376-2155
Mailing Address - Street 1:15348 SW 33RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4820
Mailing Address - Country:US
Mailing Address - Phone:786-376-2155
Mailing Address - Fax:
Practice Address - Street 1:15348 SW 33RD LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4820
Practice Address - Country:US
Practice Address - Phone:786-376-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10908310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL10908Medicaid