Provider Demographics
NPI:1922095975
Name:MAPLEWOOD MANOR INC
Entity Type:Organization
Organization Name:MAPLEWOOD MANOR INC
Other - Org Name:MAPLEWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-636-3400
Mailing Address - Street 1:204 N KEOKUK WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:IA
Mailing Address - Zip Code:52248-9496
Mailing Address - Country:US
Mailing Address - Phone:641-636-3400
Mailing Address - Fax:641-636-3150
Practice Address - Street 1:204 N KEOKUK WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:IA
Practice Address - Zip Code:52248-9496
Practice Address - Country:US
Practice Address - Phone:641-636-3400
Practice Address - Fax:641-636-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA540351314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802512Medicaid
IA165355Medicare Oscar/Certification