Provider Demographics
NPI:1568504264
Name:MAPLE STAR NEVADA
Entity Type:Organization
Organization Name:MAPLE STAR NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BREEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOERNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-747-6694
Mailing Address - Street 1:620 N CRAYCROFT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1448
Mailing Address - Country:US
Mailing Address - Phone:520-747-6694
Mailing Address - Fax:520-747-6613
Practice Address - Street 1:2965 S JONES BLVD STE E1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5606
Practice Address - Country:US
Practice Address - Phone:702-733-8098
Practice Address - Fax:702-395-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)