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General NPI Number Information
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NPI Number | 1447340591
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Entity Type | Organization
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Legal Business Name | CEDAR TREE MINISTRIES, INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1571 MORGAN RD SW
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City | SUPPLY
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State | NC
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Zip | 28462-3135
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Country | US
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Telephone | 910-846-2011
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Fax | 910-846-2311
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Provider Business Mailing Address
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Address Line | 1565 MORGAN RD SW
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City | SUPPLY
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State | NC
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Zip | 28462-3135
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Country | US
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Telephone | 910-846-5635
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Fax | 910-846-2311
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SAUNDRA ROCHELLE FANTI
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Credential |
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Telephone | 910-846-5635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-010-052
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License Number State | NC
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