Organization
MAPLE MANOR REHABILITATION CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STELLA EVANGELISTA M.D. (ADMINISTRATOR/ MEDICAL DIRECTOR)
(734) 727-0440
Entity
Organization
Contact information
Practice address
3999 VENOY RD, WAYNE, MI 48184-1485
(734) 727-0440
(734) 727-0441
Mailing address
3999 VENOY RD, WAYNE, MI 48184-1485
(734) 727-0440
(734) 727-0441
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
235613
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09896
BCBS
MI
Enumeration date
09/15/2005
Last updated
12/10/2010
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