Provider Demographics
NPI:1376217695
Name:REDMAPLEPLACE1LLC
Entity Type:Organization
Organization Name:REDMAPLEPLACE1LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-217-7327
Mailing Address - Street 1:6521 RED MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3225
Mailing Address - Country:US
Mailing Address - Phone:248-217-7327
Mailing Address - Fax:586-619-7143
Practice Address - Street 1:6521 RED MAPLE LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3225
Practice Address - Country:US
Practice Address - Phone:248-217-7327
Practice Address - Fax:586-619-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care