Maple Ridge Residential Care LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

033512 Issued in MO

Legal business name

MAPLE RIDGE RESIDENTIAL CARE LLC

Practice address

1034 Doris Dr
Farmington, MO 63640-1954

Phone

(573) 760-0155

Fax

(573) 760-0524

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Patricia Anderson

Title

Secretary

Phone

(573) 546-1616

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992822639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 S MAIN ST",
            "address_2": "SUITE B",
            "city": "IRONTON",
            "state": "MO",
            "postal_code": "636501307",
            "telephone_number": "573-546-1616",
            "fax_number": "573-546-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 DORIS DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401954",
            "telephone_number": "573-760-0155",
            "fax_number": "573-760-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE RIDGE RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "573-546-1616"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MO",
            "license": "033512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bob Hollis Lype, O.D.
• Connie Marie Macbride, MA, LPC, NCC
• Tereesa Mahoney
• Ghulam Makhdoom, DDS
• Maple Ridge Residential Care Center, LLC
• Marissa Phegley LPC LLC
• Hannah Jane Marler
• Brian Martin, DPM
• Jockese Martin, A.S.S.
• Eliot G Masek, O.D.

• Assisted Living Facility (Mental Illness) in Farmington, MO
• Providers in Farmington, MO by specialty
• Assisted Living Facility (Mental Illness) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.