Basic Information
| Provider Information | |||||||||
| NPI: | 1063779460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR RIDGE BEHAVIORAL HEALTH SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 WOODLAWN AVE | ||||||||
| Address2: | SUITE112 | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437253094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556927247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 841 STEUBENVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556927247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BEYNON | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8556927247 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LISW-S, LICDC-CS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | I.0700055-SUPV | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.