Mira Group Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

595798 Issued in FL

Legal business name

MIRA GROUP HOME

Practice address

1501 Crest CT
Valrico, FL 33594-5107

Phone

(813) 654-6579

NPI assigned

Aug 28, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Patricia Louise Mira

Title

Director

Phone

(813) 654-6579

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1609322866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 CREST CT",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335945107",
            "telephone_number": "813-654-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 CREST CT",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335945107",
            "telephone_number": "813-654-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRA GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "MIRA",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "813-654-6579",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "595798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Michnowicz, PHARM.D.
• Jewel Miiler, HCP
• Andrew M Miller, CRNA
• Nickie Milton, APRN
• Izabell Mingus
• Fabiana Garcia Miranda, WSC
• Thayra Michelle Molinary, PHARMD
• Jocelyne Monperousse
• Catherine Montero
• Brent D Mook Sang, M.D.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Valrico, FL
• Providers in Valrico, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.