Organization
INDIGO PALMS AT MAITLAND, LLC
Active
Other names
INDIGO PALMS AT MAITLAND
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDOLPH L KERNON II (VICE PRESIDENT)
(386) 257-4400
Entity
Organization
Contact information
Practice address
740 N WYMORE RD, MAITLAND, FL 32751-4237
(407) 628-0123
Mailing address
595 N WILLIAMSON BLVD, DAYTONA BEACH, FL 32114-7185
(386) 257-4400
(386) 257-4372
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/21/2007
Last updated
12/21/2007
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