Provider Demographics
NPI:1346743531
Name:MA MAISON LLC
Entity type:Organization
Organization Name:MA MAISON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABATTE-DENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-588-7480
Mailing Address - Street 1:281 SW BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6940
Mailing Address - Country:US
Mailing Address - Phone:772-207-5597
Mailing Address - Fax:772-361-6585
Practice Address - Street 1:281 SW BEDFORD RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6940
Practice Address - Country:US
Practice Address - Phone:772-207-5597
Practice Address - Fax:772-361-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home