Healthcare Provider Details

I. General information

NPI: 1780528232
Provider Name (Legal Business Name): MAZE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MARSHALL ST
MANITOWOC WI
54220-5333
US

IV. Provider business mailing address

609 MARSHALL ST
MANITOWOC WI
54220-5333
US

V. Phone/Fax

Practice location:
  • Phone: 920-905-3584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHEANA BLACKMON
Title or Position: OWNER/OPERATOR
Credential:
Phone: 920-905-3584