Provider Demographics
NPI:1841470374
Name:MAPLE LAWN HOMES INC.
Entity type:Organization
Organization Name:MAPLE LAWN HOMES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-467-2337
Mailing Address - Street 1:700 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1085
Mailing Address - Country:US
Mailing Address - Phone:309-467-2337
Mailing Address - Fax:309-467-9097
Practice Address - Street 1:700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1085
Practice Address - Country:US
Practice Address - Phone:309-467-2337
Practice Address - Fax:309-467-9097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAPLE LAWN HOMES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center