Provider Demographics
NPI:1902131543
Name:MAPLECREST MANOR INC.
Entity Type:Organization
Organization Name:MAPLECREST MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VANSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-254-1495
Mailing Address - Street 1:W304N1860 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4709
Mailing Address - Country:US
Mailing Address - Phone:414-254-1495
Mailing Address - Fax:
Practice Address - Street 1:150 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-2012
Practice Address - Country:US
Practice Address - Phone:920-748-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10341310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility