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General NPI Number Information
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NPI Number | 1609501436
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Entity Type | Organization
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Legal Business Name | MAVERICK NEUROLOGICAL HEALTHCARE GROUP, INC.
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Dates
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Enumeration Date | 07/17/2022
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 120 VANTIS DR STE 300
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2677
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Country | US
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Telephone | 949-216-5185
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Fax | 949-299-2715
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Provider Business Mailing Address
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Address Line | 120 VANTIS DR STE 300
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2677
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Country | US
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Telephone | 949-216-5185
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Fax | 949-299-2715
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. SHARON SURETTE JOHNSON
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Credential |
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Telephone | 949-216-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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