# MAPLE GROVE SENIOR LIVING LLC

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

## Provider details

- **NPI number:** 1871326710
- **Authorized official:** DOUGLAS P COX (TRUSTEE)
- **Authorized official phone:** (615) 478-6181

## Contact information

- **Practice address:** 711 FRANKFORT RD, SHELBYVILLE, KY 40065-9447
- **Practice address phone:** (502) 633-3486
- **Mailing address:** 411 INDUSTRIAL DR, WHITE HOUSE, TN 37188-8150
- **Mailing address phone:** (615) 478-6181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/26/2024
- **Last updated:** 08/26/2024