Provider Demographics
NPI:1538321559
Name:LIZMARY SENIOR CARE
Entity Type:Organization
Organization Name:LIZMARY SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-0972
Mailing Address - Street 1:16671 SW 52ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16671 SW 52ND LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5274
Practice Address - Country:US
Practice Address - Phone:305-228-0972
Practice Address - Fax:305-228-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11096310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14033422Medicaid
FL14005980Medicaid