Provider Demographics
NPI:1851437743
Name:TWIN MAPLES HEALTH CARE FACILITY
Entity Type:Organization
Organization Name:TWIN MAPLES HEALTH CARE FACILITY
Other - Org Name:TWIN MAPLES HOME, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-349-1041
Mailing Address - Street 1:809 NEW HAVEN RD # R
Mailing Address - Street 2:P O BOX 423
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-2412
Mailing Address - Country:US
Mailing Address - Phone:860-349-1041
Mailing Address - Fax:860-349-1043
Practice Address - Street 1:809 NEW HAVEN RD # R
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-2412
Practice Address - Country:US
Practice Address - Phone:860-349-1041
Practice Address - Fax:860-349-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2315314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000023151Medicaid
CT075431Medicare ID - Type UnspecifiedPROVIDER #