Healthcare Provider Details

I. General information

NPI: 1326041914
Provider Name (Legal Business Name): THE MAPLES HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BLAND ST
BLUEFIELD WV
24701-3775
US

IV. Provider business mailing address

1600 BLAND ST
BLUEFIELD WV
24701-3775
US

V. Phone/Fax

Practice location:
  • Phone: 304-327-2485
  • Fax: 304-323-1054
Mailing address:
  • Phone: 304-327-2485
  • Fax: 304-323-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number506061
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number57
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number57
License Number StateWV

VIII. Authorized Official

Name: MRS. BRENDA K. EPPERSON
Title or Position: ADMINISTRATOR
Credential: BSN,NHA,CALA
Phone: 304-327-2485