MEDICARE: MAPLE VALLEY NURSING HOME OF MAPLE CITY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	454010	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09960	OTHER	MI	BCBSM PROVIDER ID

General Provider Information

NPI Number	:	1144223587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE VALLEY NURSING HOME OF MAPLE CITY, INC.

Provider Business Mailing Address
First Line	:	1086 W BURDICKVILLE RD
Second Line	:
City	:	MAPLE CITY
State	:	MI
Zip	:	49664-8769
Country	:	US
Telephone Number	:	231-228-5895
Fax Number	:	231-228-7512

Provider Business Practice Location Address
First Line	:	1086 W BURDICKVILLE RD
Second Line	:
City	:	MAPLE CITY
State	:	MI
Zip	:	49664-8769
Country	:	US
Telephone Number	:	231-228-5895
Fax Number	:	231-228-7512

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER/VICE-PRESIDENT
Name	:	MR. JOHN M KASBEN SR.
Credential	:
Telephone Number	:	231-228-5895

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/11/2022

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