Provider Demographics
NPI:1093575854
Name:THE MAPLETON 1419 ANDOVER HOME PLUS LLC
Entity Type:Organization
Organization Name:THE MAPLETON 1419 ANDOVER HOME PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:N
Authorized Official - Last Name:THORNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-500-7403
Mailing Address - Street 1:738 W 2525 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9183
Mailing Address - Country:US
Mailing Address - Phone:801-941-5893
Mailing Address - Fax:
Practice Address - Street 1:1419 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7202
Practice Address - Country:US
Practice Address - Phone:316-500-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility