Organization
FAIRLAWNS RESIDENTIAL HOME GROUP LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DYNETTA ROBINSON (OWNER)
(305) 335-5105
Entity
Organization
Contact information
Practice address
911 NW 198TH ST, MIAMI GARDENS, FL 33169-3012
(305) 335-5105
Mailing address
911 NW 198TH ST, MIAMI GARDENS, FL 33169-3012
(305) 335-5105
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225680101
IRS
FL
Enumeration date
07/11/2019
Last updated
09/26/2019
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