Provider Demographics
NPI:1407226004
Name:J. R. HOME RANCH #1, INC.
Entity type:Organization
Organization Name:J. R. HOME RANCH #1, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-807-8978
Mailing Address - Street 1:20700 SW 136TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1882
Mailing Address - Country:US
Mailing Address - Phone:305-255-6521
Mailing Address - Fax:305-255-6521
Practice Address - Street 1:20700 SW 136TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1882
Practice Address - Country:US
Practice Address - Phone:305-255-6521
Practice Address - Fax:305-255-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness