Provider Demographics
NPI:1104334382
Name:HERITAGE MAPLES LLC
Entity type:Organization
Organization Name:HERITAGE MAPLES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-000-0000
Mailing Address - Street 1:14282 BUSINESS CENTER DR NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1664
Mailing Address - Country:US
Mailing Address - Phone:763-595-1251
Mailing Address - Fax:
Practice Address - Street 1:14282 BUSINESS CENTER DR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1664
Practice Address - Country:US
Practice Address - Phone:763-595-1251
Practice Address - Fax:763-241-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health