Provider Demographics
NPI:1063672715
Name:MAYFIELD RETIREMENT CENTER, INC.
Entity Type:Organization
Organization Name:MAYFIELD RETIREMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEISTAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-365-6011
Mailing Address - Street 1:460 NEWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-9247
Mailing Address - Country:US
Mailing Address - Phone:352-365-6011
Mailing Address - Fax:352-365-9923
Practice Address - Street 1:460 NEWELL HILL RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9247
Practice Address - Country:US
Practice Address - Phone:352-365-6011
Practice Address - Fax:352-365-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7389310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679024100Medicaid