Healthcare Provider Details

I. General information

NPI: 1508347642
Provider Name (Legal Business Name): MAPLEWOOD GROUP AFC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 COLUMBIA HWY
EATON RAPIDS MI
48827-9276
US

IV. Provider business mailing address

PO BOX 508
EATON RAPIDS MI
48827-0508
US

V. Phone/Fax

Practice location:
  • Phone: 517-663-4203
  • Fax:
Mailing address:
  • Phone: 517-663-4203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAM230388711
License Number StateMI

VIII. Authorized Official

Name: RAUL PRESAS
Title or Position: OWNER - MEMBER
Credential:
Phone: 517-927-7996