Provider Demographics
NPI:1063826196
Name:MAYA'S HOUSE LLC
Entity Type:Organization
Organization Name:MAYA'S HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-281-9299
Mailing Address - Street 1:431 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2968
Mailing Address - Country:US
Mailing Address - Phone:646-281-9299
Mailing Address - Fax:
Practice Address - Street 1:431 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2968
Practice Address - Country:US
Practice Address - Phone:646-281-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities