Healthcare Provider Details

I. General information

NPI: 1336051028
Provider Name (Legal Business Name): CEDAR CREEK PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PHAY RD
ELK WA
99009-8669
US

IV. Provider business mailing address

1332 PHAY RD
ELK WA
99009-8669
US

V. Phone/Fax

Practice location:
  • Phone: 509-565-5962
  • Fax:
Mailing address:
  • Phone: 509-565-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. GALEN L HANSEN
Title or Position: DIRECTOR
Credential:
Phone: 509-564-5962