Provider Demographics
NPI:1093251324
Name:THE CEDAR HEALTH GROUP LLC
Entity Type:Organization
Organization Name:THE CEDAR HEALTH GROUP LLC
Other - Org Name:THE CEDAR HEALTH GROUP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIMENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-707-2779
Mailing Address - Street 1:6218 BLACK CHERRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-707-2779
Mailing Address - Fax:
Practice Address - Street 1:6218 BLACK CHERRY CIRCLE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-707-2779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC133NN1002X
MDD02091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty