Provider Demographics
NPI:1780474338
Name:LIFE WITH HOPE GROUP HOME, INC
Entity type:Organization
Organization Name:LIFE WITH HOPE GROUP HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:TANIA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-528-7264
Mailing Address - Street 1:12970 SW 280TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8571
Mailing Address - Country:US
Mailing Address - Phone:305-528-7264
Mailing Address - Fax:
Practice Address - Street 1:12970 SW 280TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8571
Practice Address - Country:US
Practice Address - Phone:305-528-7264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE WITH HOPE GROUP HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities