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NPI Code Detail

MEDICARE: CEDAR RIDGE INN, INC.

MEDICARE: CEDAR RIDGE INN, 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
1314000000XSkilled Nursing Facility1007NM

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 : 1902804156
Entity Type Code : Organization
Provider Name (Legal Business Name) : CEDAR RIDGE INN, INC.
Provider Business Mailing Address
First Line : 800 SAGUARO TRL
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-9632
Country : US
Telephone Number : 505-598-6000
Fax Number : 505-598-6009
Provider Business Practice Location Address
First Line : 800 SAGUARO TRL
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-9632
Country : US
Telephone Number : 505-598-6000
Fax Number : 505-598-6009
Authorized Official
Title or Position : MANAGEMENT
Name : MS. KRISSI ELLIOTT
Credential :
Telephone Number : 970-516-1404
Provider Enumeration Date : 07/12/2005
Last Update Date : 12/29/2016

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