Provider Demographics
NPI:1881608875
Name:NATIVITY GROUP HOME. INC.
Entity type:Organization
Organization Name:NATIVITY GROUP HOME. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:NINON
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:GROUP HOME
Authorized Official - Phone:772-468-7530
Mailing Address - Street 1:2106 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4792
Mailing Address - Country:US
Mailing Address - Phone:772-468-7530
Mailing Address - Fax:772-468-7530
Practice Address - Street 1:2106 S 26TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4792
Practice Address - Country:US
Practice Address - Phone:772-468-7530
Practice Address - Fax:772-468-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151079320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities