1063779460 NPI number — CEDAR RIDGE BEHAVIORAL HEALTH SOLUTIONS LLC

Table of content: DR. ZOE ALEXIS SHELDEN DC (NPI 1265950059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063779460 NPI number — CEDAR RIDGE BEHAVIORAL HEALTH SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR RIDGE BEHAVIORAL HEALTH SOLUTIONS LLC
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:
Provider Other Organization Name Type Code:
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:
1063779460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 WOODLAWN AVE
Provider Second Line Business Mailing Address:
SUITE112
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43725-3094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-692-7247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 STEUBENVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-692-7247
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BEYNON
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
855-692-7247

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  I.0700055-SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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