Provider Demographics
NPI:1235889593
Name:MAJESTIC CARE OF CEDAR VILLAGE LLC
Entity Type:Organization
Organization Name:MAJESTIC CARE OF CEDAR VILLAGE LLC
Other - Org Name:MAJESTIC CARE OF CEDAR VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:317-288-4029
Mailing Address - Street 1:5467 CEDAR VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8693
Mailing Address - Country:US
Mailing Address - Phone:513-754-3100
Mailing Address - Fax:513-336-3174
Practice Address - Street 1:5467 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8693
Practice Address - Country:US
Practice Address - Phone:513-754-3100
Practice Address - Fax:513-336-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2109NOtherLICENSURE