Provider Demographics
NPI:1093309452
Name:MAPLE HEALTH AND REHAB LLC
Entity Type:Organization
Organization Name:MAPLE HEALTH AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FACILITY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADMINISTRATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-342-5166
Mailing Address - Street 1:660 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WABASSO
Mailing Address - State:MN
Mailing Address - Zip Code:56293-1614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WABASSO
Practice Address - State:MN
Practice Address - Zip Code:56293-1614
Practice Address - Country:US
Practice Address - Phone:507-342-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility