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General NPI Number Information
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NPI Number | 1114754397
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Entity Type | Organization
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Legal Business Name | MAPLE VIEW ASSISTED LIVING, INC
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 4396 S LUCE RD
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City | ITHACA
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State | MI
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Zip | 48847
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Country | US
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Telephone | 989-875-3259
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Fax |
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Provider Business Mailing Address
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Address Line | 4396 S LUCE RD
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City | ITHACA
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State | MI
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Zip | 48847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHANNON RAY REIFF
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Credential | ADMIN
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Telephone | 989-388-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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