MEDICARE: MAEBAR 1 LLC

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
1	253Z00000X	In Home Supportive Care Agency
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1275381519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAEBAR 1 LLC

Provider Business Mailing Address
First Line	:	1910 GARDEN SPRINGS DR STE 260
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3664
Country	:	US
Telephone Number	:	859-224-1124
Fax Number	:	859-551-4477

Provider Business Practice Location Address
First Line	:	1910 GARDEN SPRINGS DR STE 260
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3664
Country	:	US
Telephone Number	:	859-224-1124
Fax Number	:	859-551-4477

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EDWARD EGGER
Credential	:
Telephone Number	:	206-201-9184

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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