Provider Demographics
NPI:1518781384
Name:MAVERLY ONE LLC
Entity type:Organization
Organization Name:MAVERLY ONE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:OGLIMEN
Authorized Official - Last Name:EDRADAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-297-2070
Mailing Address - Street 1:2999 DOUGLAS BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4219
Mailing Address - Country:US
Mailing Address - Phone:916-297-2070
Mailing Address - Fax:
Practice Address - Street 1:2999 DOUGLAS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4219
Practice Address - Country:US
Practice Address - Phone:916-297-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health