MEDICARE: CEDAR WOOD CARE MANAGEMENT, INC.

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1497236251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR WOOD CARE MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	2701 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2743
Country	:	US
Telephone Number	:	152-427-7800
Fax Number	:	267-519-8911

Provider Business Practice Location Address
First Line	:	2701 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2743
Country	:	US
Telephone Number	:	152-427-7800
Fax Number	:	267-519-8911

Authorized Official
Title or Position	:	HEALTH INFORMATION/COMPLIANCE MGR
Name	:	DANA BLACK
Credential	:
Telephone Number	:	215-427-7800

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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