Basic Information
| Provider Information | |||||||||
| NPI: | 1033448675 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CEDARCREST CENTER FOR CHILDREN WITH DISABILITIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033583384 | ||||||||
| FaxNumber: | 6033586485 | ||||||||
| Practice Location | |||||||||
| Address1: | 91 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034311629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033583384 | ||||||||
| FaxNumber: | 6033586485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2009 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6033583384 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 01709 | NH | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.