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Organization

BLUE LAGOON GROUP HOME INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. EUGENIA SANTANA (ADMINISTRATOR)
(786) 657-7205
Entity
Organization

Contact information

Practice address
21100 NW 28TH CT, MIAMI GARDENS, FL 33056-1105
(786) 657-7205
Mailing address
21100 NW 28TH CT, MIAMI GARDENS, FL 33056-1105
(786) 657-7205

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
FL

Other

Enumeration date
01/15/2014
Last updated
06/20/2018
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