Provider Demographics
NPI:1144227422
Name:CEDARCROFT HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CEDARCROFT HEALTH SERVICES INC
Other - Org Name:BIG BEND WOODS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-513-8738
Mailing Address - Street 1:110 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1422
Mailing Address - Country:US
Mailing Address - Phone:636-225-5144
Mailing Address - Fax:636-225-8427
Practice Address - Street 1:110 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1422
Practice Address - Country:US
Practice Address - Phone:636-225-5144
Practice Address - Fax:636-225-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031222314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101481901Medicaid
MO101481901Medicaid