1447340591 NPI number — CEDAR TREE MINISTRIES, INC

Table of content: (NPI 1447340591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447340591 NPI number — CEDAR TREE MINISTRIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR TREE MINISTRIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIRGES HOME
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447340591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1565 MORGAN RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUPPLY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28462-3135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-846-5635
Provider Business Mailing Address Fax Number:
910-846-2311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1571 MORGAN RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPPLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28462-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-846-2011
Provider Business Practice Location Address Fax Number:
910-846-2311
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FANTI
Authorized Official First Name:
SAUNDRA
Authorized Official Middle Name:
ROCHELLE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
910-846-5635

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-010-052 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6603844 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com