Provider Demographics
NPI:1477007458
Name:MAPLE CREEK HOSPICE INC
Entity Type:Organization
Organization Name:MAPLE CREEK HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KALYN
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:GLODO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-443-4671
Mailing Address - Street 1:706 S SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1940
Mailing Address - Country:US
Mailing Address - Phone:801-362-7831
Mailing Address - Fax:
Practice Address - Street 1:706 S SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1940
Practice Address - Country:US
Practice Address - Phone:618-443-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based