Healthcare Provider Details

I. General information

NPI: 1831192053
Provider Name (Legal Business Name): MAPLE MANOR NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 19TH ST NW
ROCHESTER MN
55901-1633
US

IV. Provider business mailing address

1875 19TH ST NW
ROCHESTER MN
55901-1633
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-9449
  • Fax: 507-287-0552
Mailing address:
  • Phone: 507-282-9449
  • Fax: 507-287-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00916
License Number StateMN

VIII. Authorized Official

Name: MR. PATRICK A BLUM
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-282-9449