Provider Demographics
NPI:1598317588
Name:THE MAPLETON ANDOVER LLC
Entity Type:Organization
Organization Name:THE MAPLETON ANDOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/DIRECTOR OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:316-530-1253
Mailing Address - Street 1:738 W 2525 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9183
Mailing Address - Country:US
Mailing Address - Phone:316-500-7403
Mailing Address - Fax:
Practice Address - Street 1:1419 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7202
Practice Address - Country:US
Practice Address - Phone:316-600-2343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MAPLETON MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility