Provider Demographics
NPI:1073760948
Name:CEDAR RIDGE CHILDREN'S HOME AND SCHOOL
Entity Type:Organization
Organization Name:CEDAR RIDGE CHILDREN'S HOME AND SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHATZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-582-0282
Mailing Address - Street 1:12146 CEDAR RIDGE RD
Mailing Address - Street 2:P.O. BOX 439
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-3031
Mailing Address - Country:US
Mailing Address - Phone:301-582-0282
Mailing Address - Fax:
Practice Address - Street 1:12146 CEDAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-3031
Practice Address - Country:US
Practice Address - Phone:301-582-0282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3395251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541728700Medicaid