Provider Demographics
NPI:1124630892
Name:BELIZAIRE, MOSELENE (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:MOSELENE
Middle Name:
Last Name:BELIZAIRE
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5357
Mailing Address - Country:US
Mailing Address - Phone:239-258-6862
Mailing Address - Fax:239-362-1561
Practice Address - Street 1:3411 9TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-5357
Practice Address - Country:US
Practice Address - Phone:239-258-6862
Practice Address - Fax:239-362-1561
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
FL6907016311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home