Healthcare Provider Details

I. General information

NPI: 1447491923
Provider Name (Legal Business Name): CEDAR HILL NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S CLARK RD
CEDAR HILL TX
75104-2750
US

IV. Provider business mailing address

121 NE LOOP 820 SUITE 300
HURST TX
76053-7375
US

V. Phone/Fax

Practice location:
  • Phone: 972-291-7877
  • Fax: 972-293-1273
Mailing address:
  • Phone: 817-457-8797
  • Fax: 817-457-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROLYN GOODMAN
Title or Position: PRESIDENT
Credential:
Phone: 817-457-8797