Healthcare Provider Details

I. General information

NPI: 1548814569
Provider Name (Legal Business Name): THREE CEDARS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N JEFFERS ST
NORTH PLATTE NE
69101-3028
US

IV. Provider business mailing address

1007 N JEFFERS ST
NORTH PLATTE NE
69101-3028
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3960
  • Fax:
Mailing address:
  • Phone: 308-532-3960
  • Fax: 308-532-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE RALPH CHATELAIN
Title or Position: OWNER
Credential:
Phone: 308-532-3960