Indigo Palms at Maitland, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

INDIGO PALMS AT MAITLAND, LLC

Doing business as

Indigo Palms at Maitland

Practice address

740 N Wymore Rd
Maitland, FL 32751-4237

Phone

(407) 628-0123

NPI assigned

Dec 21, 2007

Last updated

Dec 21, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Randolph L Kernon II

Title

Vice President

Phone

(386) 257-4400

Specialties & licenses 1

Addresses

Other names 1

• INDIGO PALMS AT MAITLAND Doing business as

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

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198195200000",
    "number": "1841474194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 N WILLIAMSON BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321147185",
            "telephone_number": "386-257-4400",
            "fax_number": "386-257-4372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 N WYMORE RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514237",
            "telephone_number": "407-628-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO PALMS AT MAITLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-21",
        "last_updated": "2007-12-21",
        "status": "A",
        "authorized_official_last_name": "KERNON",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "386-257-4400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INDIGO PALMS 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 21, 2007; 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.