1851968291 NPI number — LIFELONG CARE CORP

Table of content: SABY SZAJOWITZ D.C. (NPI 1730177049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851968291 NPI number — LIFELONG CARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFELONG CARE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851968291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 E 49TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33013-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-776-2021
Provider Business Mailing Address Fax Number:
786-776-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 E 49TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-918-2021
Provider Business Practice Location Address Fax Number:
786-677-8444
Provider Enumeration Date:
06/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MIRABAL RODRIGUEZ
Authorized Official First Name:
ROSBEL
Authorized Official Middle Name:
Authorized Official Title or Position:
FNP / OWNER
Authorized Official Telephone Number:
786-238-5581

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111525100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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