Provider Demographics
NPI:1205583002
Name:MAPLE SEED FARMS, INC.
Entity type:Organization
Organization Name:MAPLE SEED FARMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KACSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-489-1774
Mailing Address - Street 1:101 W DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1915
Mailing Address - Country:US
Mailing Address - Phone:260-415-8189
Mailing Address - Fax:260-489-1777
Practice Address - Street 1:101 W DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1915
Practice Address - Country:US
Practice Address - Phone:260-415-8189
Practice Address - Fax:260-489-1777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAPLE SEED FARMS,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty