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NPI Code Detail

MEDICARE: MAPLE SEED FARMS, INC.

MEDICARE: MAPLE SEED FARMS, 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
1251C00000XDevelopmentally Disabled Services Day Training Agency
2261QD1600XDevelopmental Disabilities Clinic/Center
3261Q00000XClinic/Center

General Provider Information

NPI Number : 1396197919
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAPLE SEED FARMS, INC.
Provider Business Mailing Address
First Line : 101 W DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1915
Country : US
Telephone Number : 260-489-1774
Fax Number : 260-489-1777
Provider Business Practice Location Address
First Line : 101 W DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1915
Country : US
Telephone Number : 260-489-1774
Fax Number : 260-489-1777
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. CYNTHA ANN KACSOR
Credential :
Telephone Number : 260-489-1774
Provider Enumeration Date : 07/07/2016
Last Update Date : 07/07/2016

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Directions to “MAPLE SEED FARMS, INC. ” Practice Location

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