# MAISON HEALTH AND SUPPORTIVE LIVING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376336453
- **Authorized official:** KAYLA LANE (CEO)
- **Authorized official phone:** (706) 207-5860

## Contact information

- **Practice address:** 603 N MAIN ST, MOULTRIE, GA 31768-3319
- **Practice address phone:** (866) 624-7660
- **Mailing address:** 136 SOUTHLAKE DR, MOULTRIE, GA 31768-7945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/22/2025
- **Last updated:** 05/23/2025