Provider Demographics
NPI:1568458271
Name:MAPLE LAWN NURSING HOME, INC.
Entity Type:Organization
Organization Name:MAPLE LAWN NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-425-2571
Mailing Address - Street 1:400 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:FULDA
Mailing Address - State:MN
Mailing Address - Zip Code:56131-1122
Mailing Address - Country:US
Mailing Address - Phone:507-425-2571
Mailing Address - Fax:507-425-2572
Practice Address - Street 1:400 7TH ST NE
Practice Address - Street 2:
Practice Address - City:FULDA
Practice Address - State:MN
Practice Address - Zip Code:56131-1122
Practice Address - Country:US
Practice Address - Phone:507-425-2571
Practice Address - Fax:507-425-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328244314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-5570Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER