Lillith Morris Group Home Inc.

Primary specialty

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

License

10001505 Issued in FL

Legal business name

LILLITH MORRIS GROUP HOME INC.

Practice address

364 San Ambrosio St
Punta Gorda, FL 33983-5767

Phone

(941) 623-0404

Fax

(941) 623-0404

NPI assigned

Feb 1, 2013

Last updated

Feb 1, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deborah Joshua

Title

Director

Phone

(941) 623-0404

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1700125374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 SAN AMBROSIO ST",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339835767",
            "telephone_number": "941-623-0404",
            "fax_number": "941-623-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 SAN AMBROSIO ST",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339835767",
            "telephone_number": "941-623-0404",
            "fax_number": "941-623-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLITH MORRIS GROUP HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "JOSHUA",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "941-623-0404"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "10001505",
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "FL",
            "license": "10001505",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PROVIDER # (DD WAIVER)",
            "identifier": "689522196",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Punta Gorda, FL
• Providers in Punta Gorda, 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 Feb 1, 2013; 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.