Healthcare Provider Details

I. General information

NPI: 1831171610
Provider Name (Legal Business Name): CEDAR CREST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S RIVER RD
JANESVILLE WI
53546-5648
US

IV. Provider business mailing address

1702 S RIVER RD
JANESVILLE WI
53546-5648
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-0344
  • Fax: 608-756-9275
Mailing address:
  • Phone: 608-756-0344
  • Fax: 608-756-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2201
License Number StateWI

VIII. Authorized Official

Name: MRS. MARION WOZNIAK
Title or Position: PRESIDENT / CEO
Credential:
Phone: 608-373-6301