Provider Demographics
NPI:1154047751
Name:MAYBERRY SENIOR SERVICES LLC
Entity type:Organization
Organization Name:MAYBERRY SENIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-271-0000
Mailing Address - Street 1:5528 EUBANK BLVD NE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1500
Mailing Address - Country:US
Mailing Address - Phone:505-271-0000
Mailing Address - Fax:
Practice Address - Street 1:5528 EUBANK BLVD NE STE 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1500
Practice Address - Country:US
Practice Address - Phone:505-271-0000
Practice Address - Fax:505-212-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care