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General NPI Number Information
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NPI Number | 1902131543
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Entity Type | Organization
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Legal Business Name | MAPLECREST MANOR INC.
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 150 N DOUGLAS ST
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City | RIPON
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State | WI
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Zip | 54971-2012
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Country | US
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Telephone | 920-748-7300
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Fax |
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Provider Business Mailing Address
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Address Line | W304N1860 MAPLE AVE
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City | PEWAUKEE
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State | WI
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Zip | 53072-4709
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Country | US
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Telephone | 414-254-1495
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DELBERT WILLIAM VANSTONE
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Credential |
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Telephone | 414-254-1495
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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 | 10341
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License Number State | WI
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