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General NPI Number Information
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NPI Number | 1144500331
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Entity Type | Organization
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Legal Business Name | CEDAR PINES, INC
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 101 W DIVISION ST
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City | WAUTOMA
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State | WI
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Zip | 54982-8467
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Country | US
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Telephone | 920-229-3664
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 506
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City | SPARTA
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State | WI
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Zip | 54656-0506
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Country | US
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Telephone | 920-229-3664
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LARENDA L ROSIN
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Credential |
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Telephone | 920-229-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | WI
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