Provider Demographics
NPI:1003490343
Name:MAJESTIC MAPLE CARE LLC
Entity Type:Organization
Organization Name:MAJESTIC MAPLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-276-3470
Mailing Address - Street 1:PO BOX 20760
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-0760
Mailing Address - Country:US
Mailing Address - Phone:267-276-3470
Mailing Address - Fax:
Practice Address - Street 1:5534 DEVON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-2316
Practice Address - Country:US
Practice Address - Phone:267-276-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care