Provider Demographics
NPI:1023413838
Name:MAPLECREST MANOR INC.
Entity type:Organization
Organization Name:MAPLECREST MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:VANSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-748-7300
Mailing Address - Street 1:150 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-2012
Mailing Address - Country:US
Mailing Address - Phone:920-748-7300
Mailing Address - Fax:920-748-7341
Practice Address - Street 1:150 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-2012
Practice Address - Country:US
Practice Address - Phone:920-748-7300
Practice Address - Fax:920-748-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0010341310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility