Basic Information
| Provider Information | |||||||||
| NPI: | 1245884469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR RIDGE CARE AND REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 OLIVER ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087012339 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 PERRYMAN ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622541356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185376165 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2019 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | SINGER | ||||||||
| AuthorizedOfficialFirstName: | MEIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6185376165 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.