MEDICARE: MAPLEWOOD NURSING HOME, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0150059MW	OTHER	NM	EXCELLUS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P106025	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1205831385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLEWOOD NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	100 DANIEL DR
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2912
Country	:	US
Telephone Number	:	585-872-1800
Fax Number	:	585-872-2597

Provider Business Practice Location Address
First Line	:	100 DANIEL DR.
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-9512
Country	:	US
Telephone Number	:	585-872-1800
Fax Number	:	585-872-2597

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GREGORY CHAMBERY
Credential	:
Telephone Number	:	585-872-1800

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/03/2021

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