Healthcare Provider Details

I. General information

NPI: 1710796107
Provider Name (Legal Business Name): MAPLEWOOD SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W MAPLE AVE
LANCASTER KY
40444-1005
US

IV. Provider business mailing address

308 W MAPLE AVE
LANCASTER KY
40444-1005
US

V. Phone/Fax

Practice location:
  • Phone: 859-792-6844
  • Fax:
Mailing address:
  • Phone: 859-792-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DILLION CARVER
Title or Position: REGIONAL DIRECTOR OF OPERATIONS
Credential:
Phone: 516-530-9510