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General NPI Number Information
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NPI Number | 1689588964
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Entity Type | Organization
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Legal Business Name | MAVERICK LIVING LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 16026 ESTATE LN
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City | LAKEVILLE
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State | MN
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Zip | 55044-2269
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Country | US
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Telephone | 619-735-8278
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Fax | 612-444-8860
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Provider Business Mailing Address
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Address Line | 16026 ESTATE LN
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City | LAKEVILLE
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State | MN
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Zip | 55044-2269
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Country | US
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Telephone | 619-735-8278
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Fax | 612-444-8860
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Authorized Official
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Title or Position | OWNER
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Name | FARHIYA ABDI
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Credential | RN
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Telephone | 619-735-8278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | NULL
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