Provider Demographics
NPI:1386394393
Name:SPRING ARBOR CROFTON MD TENANT, LLC
Entity type:Organization
Organization Name:SPRING ARBOR CROFTON MD TENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-540-7700
Mailing Address - Street 1:420 S ORANGE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4908
Mailing Address - Country:US
Mailing Address - Phone:407-540-7700
Mailing Address - Fax:
Practice Address - Street 1:1495 RIEDEL RD
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1603
Practice Address - Country:US
Practice Address - Phone:410-451-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING ARBOR MASTER TENANT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-24
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility