Provider Demographics
NPI:1659158558
Name:MAMA LLLAMA LLC, MG
Entity Type:Organization
Organization Name:MAMA LLLAMA LLC, MG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-333-4179
Mailing Address - Street 1:1074 HYACINTH PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2144
Mailing Address - Country:US
Mailing Address - Phone:561-333-4179
Mailing Address - Fax:561-331-2513
Practice Address - Street 1:13931 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8645
Practice Address - Country:US
Practice Address - Phone:561-333-4179
Practice Address - Fax:561-331-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility