MEDICARE: MAPLE MANOR, 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	520022	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5210820001	OTHER	OH	DME

General Provider Information

NPI Number	:	1619963659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE MANOR, INC.

Provider Business Mailing Address
First Line	:	5501 VERULAM AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2417
Country	:	US
Telephone Number	:	513-631-1310
Fax Number	:	513-631-1328

Provider Business Practice Location Address
First Line	:	5501 VERULAM AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2417
Country	:	US
Telephone Number	:	513-631-1310
Fax Number	:	513-631-1328

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN JAMISON
Credential	:
Telephone Number	:	513-631-1310

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	08/22/2020

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Directions to “MAPLE MANOR, INC. ” Practice Location

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