Healthcare Provider Details

I. General information

NPI: 1427829266
Provider Name (Legal Business Name): E.L. MAOR SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 42ND ST N
PINELLAS PARK FL
33781-2519
US

IV. Provider business mailing address

13013 SEMINOLE BLVD UNIT 1182
LARGO FL
33778-2124
US

V. Phone/Fax

Practice location:
  • Phone: 727-481-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: CHERIA EDWARDS
Title or Position: OWNER/OPERATOR
Credential:
Phone: 727-481-4848