Martinez Group Home, LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

L11-1108-GH Issued in FL

Legal business name

MARTINEZ GROUP HOME, LLC

Practice address

14918 SW 15 LN
Miami, FL 33194

Phone

(305) 450-7645

Fax

(786) 360-5343

NPI assigned

Jul 28, 2017

Organization subpart

No

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

Authorized official

Name

Nelson M Martinez

Title

President

Phone

(305) 450-7645

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501200000000",
    "number": "1700300092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14918 SW 15 LN",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33194",
            "telephone_number": "305-450-7645",
            "fax_number": "786-360-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14918 SW 15 LN",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33194",
            "telephone_number": "305-450-7645",
            "fax_number": "786-360-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTINEZ GROUP HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-28",
        "last_updated": "2017-07-28",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "NELSON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-450-7645"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "FL",
            "license": "L11-1108-GH",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAIVER PROVIDE",
            "identifier": "010236500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yaneisy Martinez Gonzalez, RBT
• Yeily Martinez Gonzalez
• Yorlaydis Martinez Gonzalez
• Ana Martinez Gorricho
• Alexis Martinez Grillo
• Elizabeth Martinez Guerrero
• Daimary Martinez Guevara
• Greisy Martinez Harvell
• Adisliet Martinez Hernandez
• Eneida Margarita Martinez Hernandez

• Physical Disabilities Residential Treatment Facility in Miami, FL
• Providers in Miami, FL by specialty
• Physical Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2017; 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.