Provider Demographics
NPI:1770053613
Name:MAYBERRY GARDENS INC
Entity type:Organization
Organization Name:MAYBERRY GARDENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-213-8135
Mailing Address - Street 1:3272 N GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3207
Mailing Address - Country:US
Mailing Address - Phone:972-675-3603
Mailing Address - Fax:972-675-3603
Practice Address - Street 1:3272 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3207
Practice Address - Country:US
Practice Address - Phone:972-675-3603
Practice Address - Fax:972-675-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility