Healthcare Provider Details

I. General information

NPI: 1245884469
Provider Name (Legal Business Name): CEDAR RIDGE CARE AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERRYMAN ST
LEBANON IL
62254-1356
US

IV. Provider business mailing address

14 OLIVER ST
LAKEWOOD NJ
08701-2339
US

V. Phone/Fax

Practice location:
  • Phone: 618-537-6165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MEIR SINGER
Title or Position: PRESIDENT
Credential:
Phone: 618-537-6165