Provider Demographics
NPI:1821568908
Name:MAD LIVING ASSISTANCE SERVICES, LLC
Entity Type:Organization
Organization Name:MAD LIVING ASSISTANCE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-668-4468
Mailing Address - Street 1:11310 S ORANGE BLOSSOM TRL # 124
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9421
Mailing Address - Country:US
Mailing Address - Phone:407-668-4468
Mailing Address - Fax:407-668-4694
Practice Address - Street 1:5300 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-3402
Practice Address - Country:US
Practice Address - Phone:407-668-4468
Practice Address - Fax:407-668-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health