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General NPI Number Information
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NPI Number | 1922641091
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Entity Type | Organization
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Legal Business Name | CEDAR GROVE PCH LLC
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 245 S WOODLAWN DR
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City | CRAWFORD
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State | GA
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Zip | 30630-2622
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Country | US
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Telephone | 706-743-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 245 S WOODLAWN DR
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City | CRAWFORD
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State | GA
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Zip | 30630-2622
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Country | US
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Telephone | 706-743-6133
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | LANIECE APPLING
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Credential |
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Telephone | 706-743-6133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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