# MAPLEWOOD FARM GROUP HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790814176
- **Authorized official:** MR. BRUCE KOSMISKI (OWNER)
- **Authorized official phone:** (660) 665-9336

## Contact information

- **Practice address:** 1503 E NORTHTOWN RD, KIRKSVILLE, MO 63501-2080
- **Practice address phone:** (660) 665-9336
- **Practice address fax:** (660) 665-9336
- **Mailing address:** 1503 E NORTHTOWN RD, KIRKSVILLE, MO 63501-2080
- **Mailing address phone:** (660) 665-9336
- **Mailing address fax:** (660) 665-9336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 5622-8623 | MO | Yes |

## Other

- **Enumeration date:** 03/03/2007
- **Last updated:** 06/14/2008