1285071035 NPI number — CEDAR WOODS INT'L HEALTH CARE, INC.

Table of content: (NPI 1285071035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285071035 NPI number — CEDAR WOODS INT'L HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR WOODS INT'L HEALTH CARE, 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:
EPIPHANY HOME VISITING PHYSICIANS
Provider Other Organization Name Type Code:
3
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:
1285071035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 EXCHANGE PKWY, #2304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-725-9559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 EXCHANGE PKWY APT 2304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75002-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-725-9559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DEJESUS
Authorized Official First Name:
LITA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
214-725-9559

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 303363 . This is a "PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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