Provider Demographics
NPI:1184848202
Name:CEDAR RIDGE, INC
Entity Type:Organization
Organization Name:CEDAR RIDGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:479-632-3813
Mailing Address - Street 1:107 THICKSTEN DR
Mailing Address - Street 2:P.O. BOX 2389
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921
Mailing Address - Country:US
Mailing Address - Phone:479-632-3813
Mailing Address - Fax:479-632-8986
Practice Address - Street 1:107 THICKSTEN DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921
Practice Address - Country:US
Practice Address - Phone:479-632-3813
Practice Address - Fax:479-632-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04-G030320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities