Provider Demographics
NPI:1033436951
Name:1 ZOURCE LIVING CARE
Entity Type:Organization
Organization Name:1 ZOURCE LIVING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALUBAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-826-7813
Mailing Address - Street 1:16808 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4635
Mailing Address - Country:US
Mailing Address - Phone:954-826-7813
Mailing Address - Fax:305-945-4186
Practice Address - Street 1:1401 NE 176TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1363
Practice Address - Country:US
Practice Address - Phone:954-826-7813
Practice Address - Fax:305-945-4186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1 ZOURCE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL143061100Medicaid