Provider Demographics
NPI:1447755376
Name:JACKIE MAUERSBERGER LLC
Entity Type:Organization
Organization Name:JACKIE MAUERSBERGER LLC
Other - Org Name:ST. JULIANNA CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESPALDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-308-0935
Mailing Address - Street 1:5701 E LUSH VISTA VW
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-8011
Mailing Address - Country:US
Mailing Address - Phone:702-308-0935
Mailing Address - Fax:
Practice Address - Street 1:5701 E LUSH VISTA VW
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-8011
Practice Address - Country:US
Practice Address - Phone:702-308-0935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care