Provider Demographics
NPI:1588209142
Name:MAPLE CITY HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:MAPLE CITY HEALTH CARE CENTER, INC
Other - Org Name:MAPLE CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-534-0088
Mailing Address - Street 1:213 MIDDLEBURY ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-2956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:814 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-2632
Practice Address - Country:US
Practice Address - Phone:574-534-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAPLE CITY HEALTH CARE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-07
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)