Organization
MARTINEZ GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON M MARTINEZ (PRESIDENT)
(305) 450-7645
Entity
Organization
Contact information
Practice address
14918 SW 15 LN, MIAMI, FL 33194
(305) 450-7645
(786) 360-5343
Mailing address
14918 SW 15 LN, MIAMI, FL 33194
(305) 450-7645
(786) 360-5343
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
L11-1108-GH
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010236500
MEDICAID WAIVER PROVIDE
FL
Enumeration date
07/28/2017
Last updated
07/28/2017
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