MEDICARE: CEDAR SENIOR LIVING, INC.

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1255846937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR SENIOR LIVING, INC.

Provider Business Mailing Address
First Line	:	602 E BELT LINE RD
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-2260
Country	:	US
Telephone Number	:	972-291-5000
Fax Number	:	972-291-5046

Provider Business Practice Location Address
First Line	:	602 E BELT LINE RD
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-2260
Country	:	US
Telephone Number	:	972-291-5000
Fax Number	:	972-291-5046

Authorized Official
Title or Position	:	SECRETARY
Name	:	AMBER L TUELLER
Credential	:
Telephone Number	:	208-207-2726

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	06/11/2025

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