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General NPI Number Information
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NPI Number | 1376336453
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Entity Type | Organization
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Legal Business Name | MAISON HEALTH AND SUPPORTIVE LIVING LLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 603 N MAIN ST
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City | MOULTRIE
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State | GA
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Zip | 31768-3319
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Country | US
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Telephone | 866-624-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 136 SOUTHLAKE DR
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City | MOULTRIE
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State | GA
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Zip | 31768-7945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAYLA LANE
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Credential |
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Telephone | 706-207-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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