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General NPI Number Information
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NPI Number | 1770296055
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Entity Type | Organization
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Legal Business Name | MAPLE INVESTMENT GROUP LLC
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 1207 E ROOSEVELT ST
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City | SALEM
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State | MO
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Zip | 65560-9676
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Country | US
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Telephone | 417-425-3062
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711-0191
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Country | US
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Telephone | 417-425-3062
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Fax |
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Authorized Official
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Title or Position | MANAGER AND PRESIDENT
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Name | BROOKE M BIGHAM
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Credential |
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Telephone | 417-425-3062
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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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