MEDICARE: CEDAR GROVE FAMILY CARE #2

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
1	310400000X	Assisted Living Facility	FCL068003	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1285791632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR GROVE FAMILY CARE #2

Provider Business Mailing Address
First Line	:	PO BOX 57
Second Line	:
City	:	CEDAR GROVE
State	:	NC
Zip	:	27231-0057
Country	:	US
Telephone Number	:	919-732-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 SAWMILL RD
Second Line	:
City	:	CEDAR GROVE
State	:	NC
Zip	:	27231-9295
Country	:	US
Telephone Number	:	919-732-8850
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. HANNAH M COLLINS
Credential	:
Telephone Number	:	919-732-8850

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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