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General NPI Number Information
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NPI Number | 1457174773
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Entity Type | Organization
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Legal Business Name | MAUMELLE ALF OPCO LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 101 OLYMPIA DR
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City | MAUMELLE
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State | AR
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Zip | 72113-6572
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Country | US
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Telephone | 501-803-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 1734 GILSINN LN
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City | FENTON
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State | MO
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Zip | 63026-2004
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Country | US
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Telephone | 314-440-2781
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TYLER SCOTT BRADY
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Credential |
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Telephone | 314-440-2781
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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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