Healthcare Provider Details

I. General information

NPI: 1629668850
Provider Name (Legal Business Name): MAPLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15555 GEORGE ONEAL RD
BATON ROUGE LA
70817-1514
US

IV. Provider business mailing address

14707 PERKINS RD
BATON ROUGE LA
70810-2216
US

V. Phone/Fax

Practice location:
  • Phone: 225-810-4040
  • Fax: 225-810-4050
Mailing address:
  • Phone: 225-810-4040
  • Fax: 225-810-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP SEAN WENDELL
Title or Position: CEO
Credential: CPA
Phone: 225-810-4040