Organization
MAPLEMANOR CHRISTIAN HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHERINE L. WILSON (ACCOUNTING CLERK)
(812) 246-4866
Entity
Organization
Contact information
Practice address
643 W UTICA ST, SELLERSBURG, IN 47172-1163
(812) 246-4866
(812) 246-3925
Mailing address
643 W UTICA ST, SELLERSBURG, IN 47172-1163
(812) 246-4866
(812) 246-3925
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
15-000563-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100267610A
—
IN
Enumeration date
08/18/2015
Last updated
08/18/2015
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