Provider Demographics
NPI:1528189917
Name:CEDAR CREEK ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:CEDAR CREEK ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-656-6735
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-0829
Mailing Address - Country:US
Mailing Address - Phone:910-323-8218
Mailing Address - Fax:910-485-0890
Practice Address - Street 1:1124 CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-6544
Practice Address - Country:US
Practice Address - Phone:910-323-8218
Practice Address - Fax:910-485-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-026-051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility