Provider Demographics
NPI:1801628086
Name:YAYA'S CASITA RESIDENTIAL GROUP HOME
Entity type:Organization
Organization Name:YAYA'S CASITA RESIDENTIAL GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASHIRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARRERO-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:251-458-3904
Mailing Address - Street 1:17368 NW 173RD RD
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-0069
Mailing Address - Country:US
Mailing Address - Phone:251-458-3904
Mailing Address - Fax:
Practice Address - Street 1:276 NW BURK AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3730
Practice Address - Country:US
Practice Address - Phone:251-458-3904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities