Individual ProviderJack Adrian MaestasCase Manager/Care CoordinatorOther Service ProvidersPractice Address203 California St NE, Albuquerque, NM 87108-1802(505) 308-8296PECOS EnrollmentBased on the most recent information from CMS, provider Jack Adrian Maestas does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1356937809Provider TypeIndividualFull NameMaestas, Jack AdrianCredentialCCSSGenderMaleSole ProprietorNoEnumeration Date12/18/2020Last Updated12/18/2020Contact InformationPractice LocationPractice Address203 California St NE, Albuquerque, NM 87108-1802Phone(505) 308-8296FaxUnlisted FaxMailing LocationMailing Address203 California St NE, Albuquerque, NM 87108-1802Phone(505) 308-8296FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer