Provider Demographics
NPI:1073099073
Name:GREENWICH INVESTORS CEDAR GROVE OPERATOR LLC
Entity Type:Organization
Organization Name:GREENWICH INVESTORS CEDAR GROVE OPERATOR LLC
Other - Org Name:CEDAR GROVE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT OF MANAGEMENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:779-216-5849
Mailing Address - Street 1:4882 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1461
Mailing Address - Country:US
Mailing Address - Phone:815-935-1992
Mailing Address - Fax:815-935-8380
Practice Address - Street 1:110 NICOLETTE RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-7241
Practice Address - Country:US
Practice Address - Phone:304-424-6023
Practice Address - Fax:304-424-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility