Provider Demographics
NPI:1942629860
Name:MAPLE HILL RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:MAPLE HILL RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-1700
Mailing Address - Street 1:26 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1303
Mailing Address - Country:US
Mailing Address - Phone:802-244-6403
Mailing Address - Fax:802-244-1486
Practice Address - Street 1:26 UNION ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1303
Practice Address - Country:US
Practice Address - Phone:802-244-6403
Practice Address - Fax:802-244-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0154313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility