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Organization
PEACEFUL HAVEN RANCH GROUP HOME
Active
Organization
PEACEFUL HAVEN RANCH GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERTO E FERNANDEZ (PRESIDENT)
(954) 689-0151
Entity
Organization
Contact information
Practice address
12601 STIRLING RD, SOUTHWEST RANCHES, FL 33330-3215
(954) 689-0151
(954) 680-9474
Mailing address
12601 STIRLING RD, SOUTHWEST RANCHES, FL 33330-3215
(954) 689-0151
(954) 680-9474
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
10-1606GH
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
10-1607GH
FL
Other
Enumeration date
01/23/2008
Last updated
01/23/2008
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