Provider Demographics
NPI:1912652512
Name:MIRAMAR GROUP HOME
Entity Type:Organization
Organization Name:MIRAMAR GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL RISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-498-6105
Mailing Address - Street 1:7701 SW 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3360
Mailing Address - Country:US
Mailing Address - Phone:305-432-6501
Mailing Address - Fax:786-502-4457
Practice Address - Street 1:7701 SW 133RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3360
Practice Address - Country:US
Practice Address - Phone:305-432-6501
Practice Address - Fax:786-502-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care