Provider Demographics
NPI:1033448675
Name:CEDARCREST CENTER FOR CHILDREN WITH DISABILITIES
Entity Type:Organization
Organization Name:CEDARCREST CENTER FOR CHILDREN WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:603-358-3384
Mailing Address - Street 1:91 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1629
Mailing Address - Country:US
Mailing Address - Phone:603-358-3384
Mailing Address - Fax:603-358-6485
Practice Address - Street 1:91 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1629
Practice Address - Country:US
Practice Address - Phone:603-358-3384
Practice Address - Fax:603-358-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01709313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80848084Medicare UPIN