Basic Information
| Provider Information | |||||||||
| NPI: | 1992752133 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CEDAR SPRINGS HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CEDAR SPRINGS BEHAVIORAL HEALTH SYSTEM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841005 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196334114 | ||||||||
| FaxNumber: | 7195785407 | ||||||||
| Practice Location | |||||||||
| Address1: | 2135 SOUTHGATE RD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809062605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196334114 | ||||||||
| FaxNumber: | 7195785407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | FILTON | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VP CFO | ||||||||
| AuthorizedOfficialTelephone: | 6107383300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 1099 | CO | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 323P00000X | 1517006 | CO | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 283Q00000X | 1099 | CO | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 05123313 | 05 | CO | MEDICAID | 24174203 | 05 | CO | MEDICAID | 1517006 | 05 | CO | MEDICAID |