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General NPI Number Information
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NPI Number | 1366997819
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Entity Type | Organization
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Legal Business Name | MAPLE SPRINGS MANAGEMENT, LLC
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 350 EAST 2200 NORTH
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1761
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Country | US
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Telephone | 435-753-9400
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Fax | 435-752-6602
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Provider Business Mailing Address
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Address Line | 350 EAST 2200 NORTH
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1761
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Country | US
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Telephone | 435-753-9400
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Fax | 435-752-6602
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Authorized Official
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Title or Position | CEO/OWNER
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Name | NICHOLAS ADAM LARSEN
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Credential |
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Telephone | 435-754-4034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | UT
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