Provider Demographics
NPI:1033875828
Name:WYMORE AL OPERATOR, LLC
Entity Type:Organization
Organization Name:WYMORE AL OPERATOR, LLC
Other - Org Name:AMBIANCE AT MAITLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-628-0123
Mailing Address - Street 1:7131 BUSINESS PARK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5615
Mailing Address - Country:US
Mailing Address - Phone:407-920-7030
Mailing Address - Fax:
Practice Address - Street 1:740 N. WYMORE RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-628-0123
Practice Address - Fax:407-628-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility