Provider Demographics
NPI:1720273576
Name:NORWAY MAPLE HOLDINGS, LLC
Entity Type:Organization
Organization Name:NORWAY MAPLE HOLDINGS, LLC
Other - Org Name:CRYSTAL COVE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:1445 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6152
Mailing Address - Country:US
Mailing Address - Phone:949-515-3930
Mailing Address - Fax:949-515-3974
Practice Address - Street 1:1445 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6152
Practice Address - Country:US
Practice Address - Phone:949-515-3930
Practice Address - Fax:949-515-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720273576Medicaid
CA055929Medicare Oscar/Certification