Provider Demographics
NPI:1376579904
Name:MAPLE LTC GROUP, LLC
Entity Type:Organization
Organization Name:MAPLE LTC GROUP, LLC
Other - Org Name:CUMBERLAND NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 64665
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0665
Mailing Address - Country:US
Mailing Address - Phone:910-424-9417
Mailing Address - Fax:910-423-1409
Practice Address - Street 1:2461 LEGION RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2997
Practice Address - Country:US
Practice Address - Phone:910-424-9417
Practice Address - Fax:910-423-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0501314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3435376Medicaid
NC3436308Medicaid
NC00941OtherBC/BS OF NC
NC3445376Medicaid
NC345376Medicare PIN