Provider Demographics
NPI:1609501436
Name:MAVERICK NEUROLOGICAL HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:MAVERICK NEUROLOGICAL HEALTHCARE GROUP, INC.
Other - Org Name:NEUROCARE SPECIALTY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:SURETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-216-5185
Mailing Address - Street 1:120 VANTIS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2677
Mailing Address - Country:US
Mailing Address - Phone:949-216-5185
Mailing Address - Fax:949-299-2715
Practice Address - Street 1:120 VANTIS DR STE 300
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2677
Practice Address - Country:US
Practice Address - Phone:949-216-5185
Practice Address - Fax:949-299-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty