MEDICARE: CEDAR CARE CENTER, 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	314000000X	Skilled Nursing Facility	414360	MI

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	:	1780678367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR CARE CENTER, INC

Provider Business Mailing Address
First Line	:	4630 PLAINFIELD AVENUE NE
Second Line	:	SUITE 100
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525
Country	:	US
Telephone Number	:	616-957-3975
Fax Number	:	616-957-1556

Provider Business Practice Location Address
First Line	:	400 JEFFERY ST
Second Line	:
City	:	CEDAR SPRINGS
State	:	MI
Zip	:	49319-9572
Country	:	US
Telephone Number	:	616-696-0170
Fax Number	:	616-696-4884

Authorized Official
Title or Position	:	CFO
Name	:	MR. J LINDSEY DOOD
Credential	:
Telephone Number	:	616-975-5287

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	12/10/2008

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Directions to “CEDAR CARE CENTER, INC ” Practice Location

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