Provider Demographics
NPI:1275381519
Name:MAEBAR 1 LLC
Entity Type:Organization
Organization Name:MAEBAR 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-201-9184
Mailing Address - Street 1:1910 GARDEN SPRINGS DR STE 260
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3664
Mailing Address - Country:US
Mailing Address - Phone:859-224-1124
Mailing Address - Fax:859-551-4477
Practice Address - Street 1:1910 GARDEN SPRINGS DR STE 260
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3664
Practice Address - Country:US
Practice Address - Phone:859-224-1124
Practice Address - Fax:859-551-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care