Healthcare Provider Details

I. General information

NPI: 1457427304
Provider Name (Legal Business Name): MAPLE KNOLL COMMUNITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 SPRINGFIELD PIKE
CINCINNATI OH
45246-4112
US

IV. Provider business mailing address

11100 SPRINGFIELD PIKE
CINCINNATI OH
45246-4112
US

V. Phone/Fax

Practice location:
  • Phone: 513-782-2546
  • Fax: 513-782-8306
Mailing address:
  • Phone: 513-782-2546
  • Fax: 513-782-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM FORMAL
Title or Position: PRESIDENT, CEO
Credential:
Phone: 513-782-2411