Provider Demographics
NPI:1316194921
Name:MAPLEWOOD VILLAGE INC
Entity Type:Organization
Organization Name:MAPLEWOOD VILLAGE INC
Other - Org Name:MAPLEWOOD VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-643-3383
Mailing Address - Street 1:1425 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1059
Mailing Address - Country:US
Mailing Address - Phone:608-643-3383
Mailing Address - Fax:608-643-2629
Practice Address - Street 1:1425 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1059
Practice Address - Country:US
Practice Address - Phone:608-643-3383
Practice Address - Fax:608-643-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI039310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility