MEDICARE: CEDAR CREST NURSING CENTRE 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	314000000X	Skilled Nursing Facility	669	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417954967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR CREST NURSING CENTRE INC

Provider Business Mailing Address
First Line	:	125 SCITUATE AVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02921-1838
Country	:	US
Telephone Number	:	401-944-8500
Fax Number	:	401-944-6241

Provider Business Practice Location Address
First Line	:	125 SCITUATE AVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02921-1838
Country	:	US
Telephone Number	:	401-944-8500
Fax Number	:	401-944-6241

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUSAN K. WHIPPLE
Credential	:
Telephone Number	:	401-944-8500

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/05/2007

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