Provider Demographics
NPI:1316350507
Name:MAE SERVICES LLC
Entity type:Organization
Organization Name:MAE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:806-543-0488
Mailing Address - Street 1:PO BOX 16285
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79490-6285
Mailing Address - Country:US
Mailing Address - Phone:806-543-0488
Mailing Address - Fax:866-419-7167
Practice Address - Street 1:5423 23RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2124
Practice Address - Country:US
Practice Address - Phone:806-543-0488
Practice Address - Fax:866-419-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007330315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007330Medicaid