Healthcare Provider Details

I. General information

NPI: 1366997819
Provider Name (Legal Business Name): MAPLE SPRINGS MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EAST 2200 NORTH
NORTH LOGAN UT
84341-1761
US

IV. Provider business mailing address

350 EAST 2200 NORTH
NORTH LOGAN UT
84341-1761
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-9400
  • Fax: 435-752-6602
Mailing address:
  • Phone: 435-753-9400
  • Fax: 435-752-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateUT

VIII. Authorized Official

Name: NICHOLAS ADAM LARSEN
Title or Position: CEO/OWNER
Credential:
Phone: 435-754-4034