Organization
SPIRIT RESIDENTIAL GROUP HOME
Active
Other names
Spirit Residential Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
LOLA BAIN (PRESIDENT)
(305) 623-4618
Entity
Organization
Contact information
Practice address
17311 N.W 33 CT, MIAMI GARDENS, FL 33056
(305) 623-4618
Mailing address
17311 NW 33RD CT, MIAMI GARDENS, FL 33056-4218
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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