Provider Demographics
NPI:1326041914
Name:THE MAPLES HEALTH CARE, INC
Entity Type:Organization
Organization Name:THE MAPLES HEALTH CARE, INC
Other - Org Name:THE MAPLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,NHA,CALA
Authorized Official - Phone:304-327-2485
Mailing Address - Street 1:1600 BLAND ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3775
Mailing Address - Country:US
Mailing Address - Phone:304-327-2485
Mailing Address - Fax:304-323-1054
Practice Address - Street 1:1600 BLAND ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3775
Practice Address - Country:US
Practice Address - Phone:304-327-2485
Practice Address - Fax:304-323-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV506061310400000X
WV57313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003094000Medicaid
WV0003094000Medicaid