Basic Information
| Provider Information | |||||||||
| NPI: | 1649689423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR HAVEN ACQUISITION LLC | ||||||||
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| OtherOrganizationName: | CEDAR HAVEN HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 DRYDEN RD E | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | DRESHER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190251044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154417700 | ||||||||
| FaxNumber: | 2154414255 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 S 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170429195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172740421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | D'ARCANGELO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154417700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | PA | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.