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General NPI Number Information
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NPI Number | 1336514843
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Entity Type | Organization
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Legal Business Name | MALIBU LOVE&CARE HEALTH CARE AGENCY
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 1468 S PALM AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5520
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Country | US
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Telephone | 954-362-3831
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Fax | 954-362-3832
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Provider Business Mailing Address
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Address Line | 1468 S PALM AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5520
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Country | US
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Telephone | 954-362-3831
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Fax | 954-362-3832
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. ROSEMARY NICHOLAS
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Credential |
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Telephone | 954-362-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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