Basic Information
| Provider Information | |||||||||
| NPI: | 1497210116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAPLE SENIOR LIVING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 SW 1ST LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647591772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176826184 | ||||||||
| FaxNumber: | 4176826185 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 SW 1ST LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647591772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176826184 | ||||||||
| FaxNumber: | 4176826185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | GOLDEN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4172596360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.