1215260880 NPI number — CEDAR CREEK ASSISTED LIVING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215260880 NPI number — CEDAR CREEK ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR CREEK ASSISTED LIVING
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:
1215260880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 18067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40261-0067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-259-9101
Provider Business Mailing Address Fax Number:
502-259-9109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 WINSTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-8243
Provider Business Practice Location Address Fax Number:
606-433-9805
Provider Enumeration Date:
09/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNOR
Authorized Official First Name:
LAVINIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
A/R MANAGER
Authorized Official Telephone Number:
502-259-9101

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  20011109801 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20011109801 . This is a "ASSISTED LIVING COMMUNITY CERTIFICATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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