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General NPI Number Information
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NPI Number | 1164045472
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Entity Type | Organization
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Legal Business Name | CEDAR HOUSE LLC
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 3300 COUNTY ROAD 10
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3072
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Country | US
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Telephone | 651-706-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 30TH AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55427-2305
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Country | US
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Telephone | 651-706-2670
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VINCENT JEROME KING
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Credential |
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Telephone | 651-706-2670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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