Provider Demographics
NPI:1366997819
Name:MAPLE SPRINGS MANAGEMENT, LLC
Entity type:Organization
Organization Name:MAPLE SPRINGS MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-754-4034
Mailing Address - Street 1:350 EAST 2200 NORTH
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1761
Mailing Address - Country:US
Mailing Address - Phone:435-753-9400
Mailing Address - Fax:435-752-6602
Practice Address - Street 1:350 EAST 2200 NORTH
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1761
Practice Address - Country:US
Practice Address - Phone:435-753-9400
Practice Address - Fax:435-752-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT465186OtherNORIDIAN HEALTHCARE SOLUTIONS