Provider Demographics
NPI:1588784136
Name:MAPLE HOUSE SHELTER CARE HOME, INC.
Entity type:Organization
Organization Name:MAPLE HOUSE SHELTER CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-983-5731
Mailing Address - Street 1:205 E 3RD ST
Mailing Address - Street 2:PO BOX 230
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-1624
Mailing Address - Country:US
Mailing Address - Phone:618-983-5731
Mailing Address - Fax:618-983-7101
Practice Address - Street 1:205 E 3RD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON CITY
Practice Address - State:IL
Practice Address - Zip Code:62951-1624
Practice Address - Country:US
Practice Address - Phone:618-983-5731
Practice Address - Fax:618-983-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038380177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty