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General NPI Number Information
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NPI Number | 1508347642
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Entity Type | Organization
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Legal Business Name | MAPLEWOOD GROUP AFC LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 11300 COLUMBIA HWY
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City | EATON RAPIDS
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State | MI
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Zip | 48827-9276
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Country | US
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Telephone | 517-663-4203
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 508
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City | EATON RAPIDS
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State | MI
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Zip | 48827-0508
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Country | US
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Telephone | 517-663-4203
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Fax |
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Authorized Official
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Title or Position | OWNER - MEMBER
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Name | RAUL PRESAS
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Credential |
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Telephone | 517-927-7996
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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 | AM230388711
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License Number State | MI
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