Provider Demographics
NPI:1275870982
Name:CEDAR RIDGE HEALTHCARE SYSTEM LLC
Entity Type:Organization
Organization Name:CEDAR RIDGE HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:AKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RN
Authorized Official - Phone:925-413-6139
Mailing Address - Street 1:7231 TOLOSA
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6740
Mailing Address - Country:US
Mailing Address - Phone:925-413-6139
Mailing Address - Fax:817-592-3271
Practice Address - Street 1:7231 TOLOSA
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6740
Practice Address - Country:US
Practice Address - Phone:925-413-6139
Practice Address - Fax:817-592-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX782812310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)