Organization
MA MAISON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTI LABATTE-DENEAU ANP-BC, ACHPN (OWNER/ADMINISTRATOR)
(917) 207-4785
Entity
Organization
Contact information
Practice address
281 SW BEDFORD RD, PORT ST LUCIE, FL 34953-6940
(917) 207-4785
(772) 361-8525
Mailing address
1632 SW IVY ST, PORT ST LUCIE, FL 34987-2248
(917) 207-4785
(772) 361-6585
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
10/09/2017
Last updated
10/09/2017
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