Provider Demographics
NPI:1942595210
Name:MAPLE STAR NEVADA
Entity Type:Organization
Organization Name:MAPLE STAR NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPUTIC FOSTER PARENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-852-8335
Mailing Address - Street 1:8455 OFFENHAUSER DR
Mailing Address - Street 2:#517
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1752
Mailing Address - Country:US
Mailing Address - Phone:775-852-8335
Mailing Address - Fax:
Practice Address - Street 1:8455 OFFENHAUSER DR
Practice Address - Street 2:#517
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-852-8335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVFF-125404617251S00000X
NVGF880321776-0316253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency