Organization
GOOD TIMES GROUP HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON MENDOZA (PRESIDENT)
(305) 971-0045
Entity
Organization
Contact information
Practice address
11020 SW 153RD ST, MIAMI, FL 33157-1239
(305) 971-0045
Mailing address
11020 SW 153RD ST, MIAMI, FL 33157-1239
(305) 971-0045
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
691761596
FL
Other
Enumeration date
03/10/2009
Last updated
03/10/2009
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