Healthcare Provider Details

I. General information

NPI: 1144227422
Provider Name (Legal Business Name): CEDARCROFT HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIGHLAND AVE
VALLEY PARK MO
63088-1422
US

IV. Provider business mailing address

110 HIGHLAND AVE
VALLEY PARK MO
63088-1422
US

V. Phone/Fax

Practice location:
  • Phone: 636-225-5144
  • Fax: 636-225-8427
Mailing address:
  • Phone: 636-225-5144
  • Fax: 636-225-8427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031222
License Number StateMO

VIII. Authorized Official

Name: MR. BRIAN REYNOLDS
Title or Position: CEO
Credential:
Phone: 410-513-8738