Provider Demographics
NPI:1700525870
Name:MAMA LLAMA LLC
Entity Type:Organization
Organization Name:MAMA LLAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:YIFTACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-815-7339
Mailing Address - Street 1:500 WESTOVER DR STE 81356
Mailing Address - Street 2:C/O GUY YIFTACH
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:305-815-7339
Mailing Address - Fax:
Practice Address - Street 1:1074 HYACINTH PL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2144
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:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care