Healthcare Provider Details

I. General information

NPI: 1144223587
Provider Name (Legal Business Name): MAPLE VALLEY NURSING HOME OF MAPLE CITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 W BURDICKVILLE RD
MAPLE CITY MI
49664-8769
US

IV. Provider business mailing address

1086 W BURDICKVILLE RD
MAPLE CITY MI
49664-8769
US

V. Phone/Fax

Practice location:
  • Phone: 231-228-5895
  • Fax: 231-228-7512
Mailing address:
  • Phone: 231-228-5895
  • Fax: 231-228-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number454010
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN M KASBEN SR.
Title or Position: ADMINISTRATOR/OWNER/VICE-PRESIDENT
Credential:
Phone: 231-228-5895