Organization
MAPLE PLACE LIVING CENTER, LLC
Active
Other names
Maple Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA R SIMMONS (OFFICE MANAGER)
(405) 380-6671
Entity
Organization
Contact information
Practice address
620 S ALABAMA ST, WETUMKA, OK 74883-6033
(405) 452-3271
(405) 452-5154
Mailing address
PO BOX 488, WELEETKA, OK 74880-0488
(405) 786-2266
(405) 786-2388
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
NH3207-3207
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200101970A
—
OK
Enumeration date
10/26/2006
Last updated
01/12/2023
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