Maple Crest Care Centre LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

44172 Issued in IL

Legal business name

MAPLE CREST CARE CENTRE LLC

Practice address

4452 Squaw Prairie Rd
Belvidere, IL 61008-8801

Phone

(815) 547-6377

Fax

(815) 547-3857

NPI assigned

Dec 20, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael Charles Braun

Title

Controller

Phone

(847) 583-0100

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1649256876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4452 SQUAW PRAIRIE RD",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610088801",
            "telephone_number": "815-547-6377",
            "fax_number": "815-547-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4452 SQUAW PRAIRIE RD",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610088801",
            "telephone_number": "815-547-6377",
            "fax_number": "815-547-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE CREST CARE CENTRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "BRAUN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "847-583-0100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "44172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH LICENSE NUMBER",
            "identifier": "44172",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH FACILITY NUMBER",
            "identifier": "6005706",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Therese Marie Lucietto-Sieradzki, M.D.
• Sarah Lyons, APN
• Clayton R. Malaker, M.D.
• Malcolm Pediatric Dentistry
• Andy J Malcolm, DDS
• Linda Marie McGinnis
• Ericka McKenzie, DNP, APRN, FNP-BC
• Paula M McKenzie, PT
• Lynsie Merry
• Joshua J Meyers, PT,OCS

• Skilled Nursing Facility in Belvidere, IL
• Providers in Belvidere, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.