Provider Demographics
NPI:1326049248
Name:MAPLE MANOR CARE CENTER
Entity Type:Organization
Organization Name:MAPLE MANOR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-256-2987
Mailing Address - Street 1:1116 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-1904
Mailing Address - Country:US
Mailing Address - Phone:701-256-2987
Mailing Address - Fax:701-256-5422
Practice Address - Street 1:1116 9TH AVE
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-1904
Practice Address - Country:US
Practice Address - Phone:701-256-2987
Practice Address - Fax:701-256-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1036A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1450763Medicaid