Provider Demographics
NPI:1417073412
Name:THE CEDARS OF CHAPEL HILL CLUB, INC.
Entity Type:Organization
Organization Name:THE CEDARS OF CHAPEL HILL CLUB, INC.
Other - Org Name:THE CEDARS OF CHAPEL HILL WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-259-7000
Mailing Address - Street 1:101 GREEN CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7222
Mailing Address - Country:US
Mailing Address - Phone:919-259-7934
Mailing Address - Fax:919-259-7580
Practice Address - Street 1:101 GREEN CEDAR LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-259-7934
Practice Address - Fax:919-259-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347620Medicare ID - Type UnspecifiedMEDICARE #