NPIMap

Organization Active NPI

Maple Manor Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Wayne, MI
National Provider Identifier
1053306019
Registry record updated Dec 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
235613 Issued in MI
Legal business name
MAPLE MANOR REHABILITATION CENTER LLC
Practice address
3999 Venoy Rd
Wayne, MI 48184-1485
Phone
(734) 727-0440
Fax
(734) 727-0441
NPI assigned
Sep 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stella Evangelista, M.D.
Title
Administrator/ Medical Director
Phone
(734) 727-0440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 235613 MI Primary

Addresses

Primary practice location

3999 Venoy Rd
Wayne, MI 48184-1485

Mailing address

3999 Venoy Rd
Wayne, MI 48184-1485
Phone (734) 727-0440

Other identifiers 1

IdentifierTypeStateIssuer
09896OtherMIBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100625000888 MI Part A Provider - Skilled Nursing Facility 1658283312 Practice locations: Wayne, MI

Skilled nursing facility certification: CCN 235613

Legal name
MAPLE MANOR REHABILITATION CENTER LLC
Doing business as
MAPLE MANOR REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 27, 2004
Last certification
Sep 27, 2024
Beds
59
Ownership / control type
Individual
Organization structure
LLCProprietary
Incorporated
Nov 5, 2002 in MI
Enrollment address
3999 Venoy Rd
Wayne, MI 48184-1485
Nursing home name
MAPLE MANOR REHAB CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Maple Manor Rehab CenterCCN 235613
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
May 27, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5932.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1025590Maple Manor Rehab Center3999 Venoy Road, Wayne, MI 48184Certificate of waiverMay 11, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stella S Evangelista Individual 5% Or Greater Direct Ownership Interest May 15, 2004 90%
Corporate DirectorBoard Member May 15, 2004 90%
W-2 Managing EmployeeAdministrator May 15, 2004 90%
Marcus S Evangelista Individual 5% Or Greater Direct Ownership Interest Sep 8, 2010 10%
Corporate DirectorBoard Member May 1, 2004 10%
W-2 Managing EmployeeChief Financial Officer May 1, 2004 10%

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1053306019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3999 VENOY RD",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841485",
            "telephone_number": "734-727-0440",
            "fax_number": "734-727-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 VENOY RD",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841485",
            "telephone_number": "734-727-0440",
            "fax_number": "734-727-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE MANOR REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "EVANGELISTA",
        "authorized_official_first_name": "STELLA",
        "authorized_official_title_or_position": "ADMINISTRATOR/ MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "734-727-0440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "235613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09896",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, MI

Sources for this page

Verify at the official NPI Registry.