Provider Demographics
NPI:1336514843
Name:MALIBU LOVE&CARE HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:MALIBU LOVE&CARE HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-362-3813
Mailing Address - Street 1:1468 S PALM AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5520
Mailing Address - Country:US
Mailing Address - Phone:954-362-3831
Mailing Address - Fax:954-362-3832
Practice Address - Street 1:1468 S PALM AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5520
Practice Address - Country:US
Practice Address - Phone:954-362-3831
Practice Address - Fax:954-362-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services