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General NPI Number Information
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NPI Number | 1962521070
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Entity Type | Organization
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Legal Business Name | CEDARS DDA GROUP HOME
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 838 ROSS ST
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City | BURLINGTON
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State | NC
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Zip | 27217-1651
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Country | US
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Telephone | 336-580-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 838 ROSS ST
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City | BURLINGTON
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State | NC
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Zip | 27217-1651
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Country | US
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Telephone | 336-580-0550
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | THOMAS WATLINGTON
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Credential |
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Telephone | 336-580-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | MHL-001-083
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License Number State | NC
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