Provider Demographics
NPI:1477738565
Name:MAPLE LTC GROUP, LLC
Entity Type:Organization
Organization Name:MAPLE LTC GROUP, LLC
Other - Org Name:CORNERSTONE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORWOOD
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:UZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-0948
Mailing Address - Country:US
Mailing Address - Phone:910-892-8843
Mailing Address - Fax:910-891-1945
Practice Address - Street 1:711 SUSAN TART RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5557
Practice Address - Country:US
Practice Address - Phone:910-892-8843
Practice Address - Fax:910-891-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0482313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806627Medicaid
NC7805284Medicaid