Maitland MC Real Estate, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MAITLAND MC REAL ESTATE, LLC

Practice address

701 N Maitland Ave
Maitland, FL 32751-4408

Phone

(407) 863-4020

NPI assigned

Dec 1, 2021

Organization subpart

Yes

Parent organization

PROVIDENCE SENIOR LIVINGAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Iversen

Title

Vice President of Operations

Phone

(407) 863-4020

Specialties & licenses 1

Addresses

Other names 1

• Providence Living at Maitland Doing business as

Electronic endpoints 1

Part of

Maitland MC Real Estate LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1063170629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N MAITLAND AVE",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514408",
            "telephone_number": "407-863-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N MAITLAND AVE",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514408",
            "telephone_number": "407-863-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAITLAND MC REAL ESTATE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE SENIOR LIVING",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A",
        "authorized_official_last_name": "IVERSEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "407-863-4020"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mailbox@providence-sl.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mailbox@providence-sl.com",
            "address_1": "1387 Zeek Ridge St",
            "city": "Clermont",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347150061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Providence Living at Maitland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Maitland, FL
• Providers in Maitland, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.