Provider Demographics
NPI:1174703128
Name:BURROUGHS' GROUP HOME, INC.
Entity type:Organization
Organization Name:BURROUGHS' GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MYRTICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-620-0777
Mailing Address - Street 1:3490 NW 200TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1786
Mailing Address - Country:US
Mailing Address - Phone:305-620-0777
Mailing Address - Fax:305-627-6979
Practice Address - Street 1:3490 NW 200TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1786
Practice Address - Country:US
Practice Address - Phone:305-620-0777
Practice Address - Fax:305-627-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty