Provider Demographics
NPI:1992822639
Name:MAPLE RIDGE RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:MAPLE RIDGE RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-546-1616
Mailing Address - Street 1:231 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-1307
Mailing Address - Country:US
Mailing Address - Phone:573-546-1616
Mailing Address - Fax:573-546-6465
Practice Address - Street 1:1034 DORIS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1954
Practice Address - Country:US
Practice Address - Phone:573-760-0155
Practice Address - Fax:573-760-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0335123104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness