Healthcare Provider Details

I. General information

NPI: 1790179497
Provider Name (Legal Business Name): MAPLEVIEW OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 SOUTH ST
CHARDON OH
44024-2800
US

IV. Provider business mailing address

12380 PLAZA DR
PARMA OH
44130-1043
US

V. Phone/Fax

Practice location:
  • Phone: 216-898-8399
  • Fax: 216-898-8455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2263021
License Number StateOH

VIII. Authorized Official

Name: MR. BARRY C STUMP
Title or Position: CFO
Credential: CPA
Phone: 216-898-8399