Provider Demographics
NPI:1205831385
Name:MAPLEWOOD NURSING HOME, INC.
Entity Type:Organization
Organization Name:MAPLEWOOD NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-872-1800
Mailing Address - Street 1:100 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2912
Mailing Address - Country:US
Mailing Address - Phone:585-872-1800
Mailing Address - Fax:585-872-2597
Practice Address - Street 1:100 DANIEL DR.
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9512
Practice Address - Country:US
Practice Address - Phone:585-872-1800
Practice Address - Fax:585-872-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP0150059MWOtherEXCELLUS
NY00355546Medicaid
NYP106025OtherPREFERRED CARE
NY335572Medicare ID - Type Unspecified