Provider Demographics
NPI:1982804787
Name:YOUR SO PRECIOUS GROUP HOME
Entity Type:Organization
Organization Name:YOUR SO PRECIOUS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-205-9550
Mailing Address - Street 1:8250 NW 12 COURT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147
Mailing Address - Country:US
Mailing Address - Phone:305-693-6398
Mailing Address - Fax:305-693-6398
Practice Address - Street 1:8250 NW 12 COURT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147
Practice Address - Country:US
Practice Address - Phone:305-693-6398
Practice Address - Fax:305-693-6398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10993310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility