Provider Demographics
NPI:1952466005
Name:MAPLEWOOD HOMES ASSISTED LIVING
Entity Type:Organization
Organization Name:MAPLEWOOD HOMES ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:WALLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-332-4071
Mailing Address - Street 1:326 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4271
Mailing Address - Country:US
Mailing Address - Phone:507-332-4071
Mailing Address - Fax:
Practice Address - Street 1:326 7TH ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4271
Practice Address - Country:US
Practice Address - Phone:507-332-4071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332188103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty