Basic Information
| Provider Information | |||||||||
| NPI: | 1447491923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR HILL NURSING HOME, INC. | ||||||||
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| OtherOrganizationName: | CEDAR HILL HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 NE LOOP 820 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760537375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174578797 | ||||||||
| FaxNumber: | 8174574060 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 S CLARK RD | ||||||||
| Address2: | |||||||||
| City: | CEDAR HILL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751042750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722917877 | ||||||||
| FaxNumber: | 9722931273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2009 | ||||||||
| LastUpdateDate: | 06/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOODMAN | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8174578797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001016998 | 05 | TX | MEDICAID | 005101 | 01 | TX | FACILITY ID | OTHER |