Provider Demographics
NPI:1033448287
Name:UNITED HELPERS CANTON NURSING HOME, INC
Entity Type:Organization
Organization Name:UNITED HELPERS CANTON NURSING HOME, INC
Other - Org Name:MAPLEWOOD ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-386-4541
Mailing Address - Street 1:205 STATE STREET RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3302
Mailing Address - Country:US
Mailing Address - Phone:315-386-4541
Mailing Address - Fax:315-386-2131
Practice Address - Street 1:205 STATE STREET RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3302
Practice Address - Country:US
Practice Address - Phone:315-386-4541
Practice Address - Fax:315-386-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1637L001251E00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY630E008OtherLICENSE NUMBER
NY1637L001OtherLICENSE NUMBER