Provider Demographics
NPI:1336382332
Name:MAPLE POINT
Entity Type:Organization
Organization Name:MAPLE POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-762-2506
Mailing Address - Street 1:1000 N UNION DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-1263
Mailing Address - Country:US
Mailing Address - Phone:217-762-6500
Mailing Address - Fax:217-762-6600
Practice Address - Street 1:1000 N UNION DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1263
Practice Address - Country:US
Practice Address - Phone:217-762-6500
Practice Address - Fax:217-762-6600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIATT COUNTY NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0004Medicaid