Healthcare Provider Details

I. General information

NPI: 1104262146
Provider Name (Legal Business Name): CEDAR LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W COLUMBIA ST
OBERLIN KS
67749-2450
US

IV. Provider business mailing address

810 W COLUMBIA ST
OBERLIN KS
67749-2450
US

V. Phone/Fax

Practice location:
  • Phone: 785-475-2208
  • Fax: 785-475-2453
Mailing address:
  • Phone: 785-475-2208
  • Fax: 785-475-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberH020101
License Number StateKS

VIII. Authorized Official

Name: MR. JOHNATHAN OWENS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 785-475-2208