Provider Demographics
NPI:1780093856
Name:MAPLE STAR COLORADO
Entity type:Organization
Organization Name:MAPLE STAR COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREBENIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-433-1975
Mailing Address - Street 1:2250 S ONEIDA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2556
Mailing Address - Country:US
Mailing Address - Phone:303-433-1957
Mailing Address - Fax:303-433-1980
Practice Address - Street 1:2250 S ONEIDA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2556
Practice Address - Country:US
Practice Address - Phone:303-433-1957
Practice Address - Fax:303-433-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-03
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104636253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care