MEDICARE: MAPLE LTC GROUP, 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
1	314000000X	Skilled Nursing Facility	NH0370	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00892	OTHER	NC	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558393835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE LTC GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 5021
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-1021
Country	:	US
Telephone Number	:	910-455-3610
Fax Number	:	910-455-3993

Provider Business Practice Location Address
First Line	:	1839 ONSLOW DR. EXT.
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540
Country	:	US
Telephone Number	:	910-455-3610
Fax Number	:	910-455-3993

Authorized Official
Title or Position	:	CFO
Name	:	GALE BOICE
Credential	:
Telephone Number	:	252-523-9094

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/14/2021

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Directions to “MAPLE LTC GROUP, LLC ” Practice Location

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