Provider Demographics
NPI:1073747077
Name:THE MAPLES HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:THE MAPLES HEALTH AND REHABILITATION, LLC
Other - Org Name:THE MAPLES HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-464-0200
Mailing Address - Street 1:222 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4504
Mailing Address - Country:US
Mailing Address - Phone:479-464-0200
Mailing Address - Fax:479-464-8098
Practice Address - Street 1:610 W SUNSET ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-3696
Practice Address - Country:US
Practice Address - Phone:417-891-1700
Practice Address - Fax:417-891-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO037407OtherLICENSE NUMBER
MO106915705Medicaid
MO106915705Medicaid