Provider Demographics
NPI:1851968291
Name:LIFELONG CARE, CORP
Entity Type:Organization
Organization Name:LIFELONG CARE, CORP
Other - Org Name:CONVENIENT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-238-5581
Mailing Address - Street 1:259 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-918-2021
Mailing Address - Fax:786-677-8444
Practice Address - Street 1:259 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-918-2021
Practice Address - Fax:786-677-8444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELONG CARE, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-04
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty