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NPI Code Detail

MEDICARE: MAPLE LANE HEALTH & REHABILITATION CENTER LLC

MEDICARE: MAPLE LANE HEALTH & REHABILITATION CENTER LLC
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
1314000000XSkilled Nursing Facility2579WI

General Provider Information

NPI Number : 1194048298
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAPLE LANE HEALTH & REHABILITATION CENTER LLC
Provider Business Mailing Address
First Line : 1726 N BALLARD RD
Second Line :
City : APPLETON
State : WI
Zip : 54911-2444
Country : US
Telephone Number : 920-991-9072
Fax Number : 920-749-4022
Provider Business Practice Location Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number : 715-526-6823
Authorized Official
Title or Position : CFO
Name : ROBERT M PARKINS
Credential :
Telephone Number : 920-364-9754
Provider Enumeration Date : 03/04/2010
Last Update Date : 05/27/2015

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Directions to “MAPLE LANE HEALTH & REHABILITATION CENTER LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.