=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427921741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANAVISTA II ASSISTED LIVING FACILITY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5421 TEALWOOD DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-527-6696
-----------------------------------------------------
Fax | 407-386-7501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5421 TEALWOOD DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-527-6696
-----------------------------------------------------
Fax | 407-386-7501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MAUREEN T NICHOLAS-CHANCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-527-6696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------