MEDICARE: MAPLE HILL SENIOR LIVING

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1215394952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE HILL SENIOR LIVING

Provider Business Mailing Address
First Line	:	820 LILAC DR N
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 SOUTHLAWN DR
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1577
Country	:	US
Telephone Number	:	651-363-3690
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	MRS. DIANNA DELGADO
Credential	:
Telephone Number	:	763-710-0270

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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