Mizada Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AH12155 Issued in FL

Legal business name

MIZADA INC

Doing business as

Mizada Assistant Living facility

Practice address

3726 SW Manak St
Port St Lucie, FL 34953-7705

Phone

(772) 336-5884

NPI assigned

Sep 5, 2012

Last updated

Sep 5, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Michelle Lightbourn

Title

President

Phone

(772) 336-5884

Specialties & licenses 1

Addresses

Other names 1

• Mizada Assistant Living facility Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1417206400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 SW MANAK ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349537705",
            "telephone_number": "772-336-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 SW MANAK ST",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349537705",
            "telephone_number": "772-336-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIZADA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-05",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "LIGHTBOURN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-336-5884",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AH12155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mizada Assistant Living facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.