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General NPI Number Information
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NPI Number | 1356701379
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Entity Type | Organization
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Legal Business Name | GOLDEN MAPLE HOMES, INC.
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 13104 GIRARD AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55337-2408
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Country | US
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Telephone | 952-393-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 13104 GIRARD AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55337-2408
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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 | OWNER
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Name | DR. CAROL FILLMORE
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Credential | DNP
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Telephone | 952-393-3690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 32150
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 32150
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 32150
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License Number State | MN
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