MEDICARE: CEDAR KNOLL CARE CENTER

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	314000000X	Skilled Nursing Facility

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	:	1679568455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR KNOLL CARE CENTER

Provider Business Mailing Address
First Line	:	9230 CEDAR KNOLL DR
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-9633
Country	:	US
Telephone Number	:	517-522-8471
Fax Number	:	517-522-3066

Provider Business Practice Location Address
First Line	:	9230 CEDAR KNOLL DR
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-9633
Country	:	US
Telephone Number	:	517-522-8471
Fax Number	:	517-522-3066

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN G HUPP
Credential	:
Telephone Number	:	517-522-8471

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	08/22/2020

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