Organization
MIRA GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA LOUISE MIRA (DIRECTOR)
(813) 654-6579
Entity
Organization
Contact information
Practice address
1501 CREST CT, VALRICO, FL 33594-5107
(813) 654-6579
Mailing address
1501 CREST CT, VALRICO, FL 33594-5107
(813) 654-6579
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
595798
FL
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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