Provider Demographics
NPI:1427015882
Name:CEDAR CREST VILLAGE INC
Entity Type:Organization
Organization Name:CEDAR CREST VILLAGE INC
Other - Org Name:CONTINUING CARE AT CEDAR CREST VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2390
Mailing Address - Street 1:1 CEDAR CREST VILLAGE DRIVE
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-2100
Mailing Address - Country:US
Mailing Address - Phone:973-831-3500
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:4 CEDAR CREST VILLAGE DR
Practice Address - Street 2:ATTN: EXTENDED CARE ADMINISTRATOR
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-2161
Practice Address - Country:US
Practice Address - Phone:973-831-3500
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ60922314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315491Medicare Oscar/Certification