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General NPI Number Information
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NPI Number | 1871614859
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Entity Type | Organization
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Legal Business Name | MAPLE GROVE NURSING HOME INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 93 MILITARY ST
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City | HOULTON
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State | ME
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Zip | 04730-2421
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Country | US
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Telephone | 207-532-6593
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Fax | 207-532-4456
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Provider Business Mailing Address
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Address Line | 93 MILITARY ST
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City | HOULTON
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State | ME
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Zip | 04730-2421
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Country | US
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Telephone | 207-532-6593
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Fax | 207-532-4456
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Authorized Official
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Title or Position | MANAGER
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Name | JIM BROWN
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Credential |
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Telephone | 207-532-6593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 2054
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License Number State | ME
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