MEDICARE: MAPLE TREE HOME HEALTH, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225573595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE TREE HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	27911 CROWN LAKE BLVD
Second Line	:	STE 245
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4210
Country	:	US
Telephone Number	:	709-757-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	27911 CROWN LAKE BLVD
Second Line	:	STE 245
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4210
Country	:	US
Telephone Number	:	709-757-3530
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNE WHELAN
Credential	:
Telephone Number	:	709-757-3530

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	01/04/2017

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