Healthcare Provider Details

I. General information

NPI: 1245508761
Provider Name (Legal Business Name): MAPLEWOOD SUPPORTIVE LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21755 MAPLEWOOD DR
SOUTHFIELD MI
48033-3601
US

IV. Provider business mailing address

37637 5 MILE RD #223
LIVONIA MI
48154-1543
US

V. Phone/Fax

Practice location:
  • Phone: 734-612-5957
  • Fax: 734-956-4155
Mailing address:
  • Phone: 734-612-5957
  • Fax: 734-956-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberAS630295056
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS630295056
License Number StateMI

VIII. Authorized Official

Name: MS. DOROTHY STRONG-STOKES
Title or Position: PRESIDENT-CEO
Credential: LMSW, CBIS, C-ASWCM
Phone: 734-612-5957