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General NPI Number Information
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NPI Number | 1033875828
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Entity Type | Organization
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Legal Business Name | WYMORE AL OPERATOR, LLC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 740 N. WYMORE RD
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 407-628-0123
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Fax | 407-628-5525
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Provider Business Mailing Address
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Address Line | 7131 BUSINESS PARK LN
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City | LAKE MARY
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State | FL
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Zip | 32746-5615
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Country | US
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Telephone | 407-920-7030
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KAREN DECKER
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Credential |
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Telephone | 407-628-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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