Provider Demographics
NPI:1528667011
Name:AFFLUENT LIVING ADULT CARE
Entity type:Organization
Organization Name:AFFLUENT LIVING ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-365-6629
Mailing Address - Street 1:4106 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7503
Mailing Address - Country:US
Mailing Address - Phone:410-365-6629
Mailing Address - Fax:
Practice Address - Street 1:4106 MAINE AVE
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-7503
Practice Address - Country:US
Practice Address - Phone:410-365-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility