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NPI Code Detail

MEDICARE: MAPLE STAR NEVADA

MEDICARE: MAPLE STAR NEVADA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1124160825
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAPLE STAR NEVADA
Provider Business Mailing Address
First Line : 620 N CRAYCROFT RD
Second Line :
City : TUCSON
State : AZ
Zip : 85711-1448
Country : US
Telephone Number : 520-747-6694
Fax Number : 520-747-6613
Provider Business Practice Location Address
First Line : 2965 S JONES BLVD STE E1
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-5606
Country : US
Telephone Number : 702-733-8098
Fax Number : 702-395-6457
Authorized Official
Title or Position : AR BILLING MANAGER
Name : BREEANN HOERNING
Credential :
Telephone Number : 520-747-6694
Provider Enumeration Date : 02/12/2007
Last Update Date : 08/22/2020

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Directions to “MAPLE STAR NEVADA ” Practice Location

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