Provider Demographics
NPI:1962686444
Name:MAPLE LTC GROUP, LLC
Entity Type:Organization
Organization Name:MAPLE LTC GROUP, LLC
Other - Org Name:HIGHLAND ACRES NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:1435 HIGHWAY 258N
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7208
Mailing Address - Country:US
Mailing Address - Phone:252-523-9094
Mailing Address - Fax:
Practice Address - Street 1:1170 LINKHAW RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2524
Practice Address - Country:US
Practice Address - Phone:910-671-1163
Practice Address - Fax:910-671-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0472310400000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806630Medicaid
NC7805285Medicaid