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NPI Code Detail

MEDICARE: CEDAR CREST

MEDICARE: CEDAR CREST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility182-19WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013347830
Entity Type Code : Organization
Provider Name (Legal Business Name) : CEDAR CREST
Provider Business Mailing Address
First Line : 1072 S RIVER ROAD
Second Line :
City : JANESVILLE
State : WI
Zip : 53546
Country : US
Telephone Number : 608-373-6322
Fax Number :
Provider Business Practice Location Address
First Line : 1072 S RIVER ROAD
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-5648
Country : US
Telephone Number : 608-373-6322
Fax Number :
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : EMILY MARTIN
Credential :
Telephone Number : 608-373-6322
Provider Enumeration Date : 11/14/2013
Last Update Date : 11/14/2013

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Directions to “CEDAR CREST ” Practice Location

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