Healthcare Provider Details

I. General information

NPI: 1124762117
Provider Name (Legal Business Name): CEDAR HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 03/15/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY ROAD 10
BROOKLYN CENTER MN
55429-3072
US

IV. Provider business mailing address

3300 COUNTY ROAD 10
BROOKLYN CENTER MN
55429-3072
US

V. Phone/Fax

Practice location:
  • Phone: 651-428-0945
  • Fax:
Mailing address:
  • Phone: 651-428-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PAMELA KING
Title or Position: PRESIDENT
Credential:
Phone: 651-428-9045