Healthcare Provider Details

I. General information

NPI: 1952279796
Provider Name (Legal Business Name): GAIA GROVE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5378 TIMBERLAND AVE
SAINT CLOUD FL
34771-0112
US

IV. Provider business mailing address

16750 ABBEY HILL CT
CLERMONT FL
34711-6353
US

V. Phone/Fax

Practice location:
  • Phone: 407-484-3663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: OLGA T GALBAN
Title or Position: OWNER
Credential: MHA
Phone: 407-484-3663