Organization
MAITLAND MC REAL ESTATE, LLC
Active
Parent organization
PROVIDENCE SENIOR LIVING
Other names
Providence Living at Maitland
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE SENIOR LIVING
Authorized official
GARY IVERSEN (VICE PRESIDENT OF OPERATIONS)
(407) 863-4020
Entity
Organization
Contact information
Practice address
701 N MAITLAND AVE, MAITLAND, FL 32751-4408
(407) 863-4020
Mailing address
701 N MAITLAND AVE, MAITLAND, FL 32751-4408
(407) 863-4020
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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