Provider Demographics
NPI:1083303390
Name:MAYMONT SENIOR ADVOCATE GROUP LLC
Entity Type:Organization
Organization Name:MAYMONT SENIOR ADVOCATE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE-LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-888-7654
Mailing Address - Street 1:2578 LIMERICK CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9006
Mailing Address - Country:US
Mailing Address - Phone:352-870-3439
Mailing Address - Fax:352-818-4476
Practice Address - Street 1:2578 LIMERICK CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-9006
Practice Address - Country:US
Practice Address - Phone:352-888-7654
Practice Address - Fax:352-818-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health