Provider Demographics
NPI:1053112508
Name:LIFECARE MEDICAL CENTER GROUP LLC
Entity type:Organization
Organization Name:LIFECARE MEDICAL CENTER GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISSUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-608-9889
Mailing Address - Street 1:14221 SW 120TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4225
Mailing Address - Country:US
Mailing Address - Phone:786-608-9889
Mailing Address - Fax:
Practice Address - Street 1:14221 SW 120TH ST STE 225
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4225
Practice Address - Country:US
Practice Address - Phone:786-608-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center