MEDICARE: CEDAR GREEN RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1013658194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR GREEN RECOVERY LLC

Provider Business Mailing Address
First Line	:	150 CEDAR LN
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458-8539
Country	:	US
Telephone Number	:	630-334-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 CEDAR LN
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458-8539
Country	:	US
Telephone Number	:	630-334-2019
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. THOMAS ANDREW FERENCE JR.
Credential	:
Telephone Number	:	630-334-2019

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	08/22/2024

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