Organization
LILLITH MORRIS GROUP HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH JOSHUA (DIRECTOR)
(941) 623-0404
Entity
Organization
Contact information
Practice address
364 SAN AMBROSIO ST, PUNTA GORDA, FL 33983-5767
(941) 623-0404
(941) 623-0404
Mailing address
364 SAN AMBROSIO ST, PUNTA GORDA, FL 33983-5767
(941) 623-0404
(941) 623-0404
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
10001505
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
10001505
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
689522196
MEDICAID PROVIDER # (DD WAIVER)
FL
Enumeration date
02/01/2013
Last updated
02/01/2013
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