Organization
YAYA'S CASITA RESIDENTIAL GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YASHIRA MARIE MARRERO-SMITH RN (OWNER)
(251) 458-3904
Entity
Organization
Contact information
Practice address
276 NW BURK AVE, LAKE CITY, FL 32055-3730
(251) 458-3904
Mailing address
17368 NW 173RD RD, ALACHUA, FL 32615-0069
(251) 458-3904
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/16/2024
Last updated
08/16/2024
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