Provider Demographics
NPI:1396197919
Name:MAPLE SEED FARMS, INC.
Entity Type:Organization
Organization Name:MAPLE SEED FARMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KACSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-489-1774
Mailing Address - Street 1:101 W DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1915
Mailing Address - Country:US
Mailing Address - Phone:260-489-1774
Mailing Address - Fax:260-489-1777
Practice Address - Street 1:101 W DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1915
Practice Address - Country:US
Practice Address - Phone:260-489-1774
Practice Address - Fax:260-489-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities