Healthcare Provider Details

I. General information

NPI: 1033875828
Provider Name (Legal Business Name): WYMORE AL OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N. WYMORE RD
MAITLAND FL
32751
US

IV. Provider business mailing address

7131 BUSINESS PARK LN
LAKE MARY FL
32746-5615
US

V. Phone/Fax

Practice location:
  • Phone: 407-628-0123
  • Fax: 407-628-5525
Mailing address:
  • Phone: 407-920-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN DECKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-628-0123