Healthcare Provider Details

I. General information

NPI: 1871614859
Provider Name (Legal Business Name): MAPLE GROVE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MILITARY ST
HOULTON ME
04730-2421
US

IV. Provider business mailing address

93 MILITARY ST
HOULTON ME
04730-2421
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-6593
  • Fax: 207-532-4456
Mailing address:
  • Phone: 207-532-6593
  • Fax: 207-532-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number2054
License Number StateME

VIII. Authorized Official

Name: JIM BROWN
Title or Position: MANAGER
Credential:
Phone: 207-532-6593