Organization
MIZADA INC
Active
Other names
Mizada Assistant Living facility
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE LIGHTBOURN (PRESIDENT)
(772) 336-5884
Entity
Organization
Contact information
Practice address
3726 SW MANAK ST, PORT ST LUCIE, FL 34953-7705
(772) 336-5884
Mailing address
3726 SW MANAK ST, PORT ST LUCIE, FL 34953-7705
(772) 336-5884
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AH12155
FL
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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