Provider Demographics
NPI:1932755014
Name:ABC GROUP HOME CORP
Entity Type:Organization
Organization Name:ABC GROUP HOME CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZURBANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-356-0630
Mailing Address - Street 1:10310 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4932
Mailing Address - Country:US
Mailing Address - Phone:786-356-0630
Mailing Address - Fax:
Practice Address - Street 1:10310 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4932
Practice Address - Country:US
Practice Address - Phone:786-356-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004086600Medicaid