Provider Demographics
NPI:1851822167
Name:MAPLELAKEBUILDERS
Entity Type:Organization
Organization Name:MAPLELAKEBUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CASHEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OWNER
Authorized Official - Phone:269-674-9870
Mailing Address - Street 1:508 N KALAMAZOO ST
Mailing Address - Street 2:SAME
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1130
Mailing Address - Country:US
Mailing Address - Phone:269-364-4395
Mailing Address - Fax:
Practice Address - Street 1:508 N KALAMAZOO ST
Practice Address - Street 2:SAME
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1130
Practice Address - Country:US
Practice Address - Phone:269-364-4395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty