Provider Demographics
NPI:1043792872
Name:MAIDEN SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:MAIDEN SUPPORT SERVICES LLC
Other - Org Name:MAIDEN SUPPORT SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ATEH
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:609-207-7025
Mailing Address - Street 1:101 E GIBBSBORO RD APT 1307
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1920
Mailing Address - Country:US
Mailing Address - Phone:609-207-7025
Mailing Address - Fax:856-266-9128
Practice Address - Street 1:101 E GIBBSBORO RD APT 1307
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-1920
Practice Address - Country:US
Practice Address - Phone:609-207-7025
Practice Address - Fax:856-266-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251B00000XAgenciesCase Management