Provider Demographics
NPI:1588841159
Name:CEDAR PLACE LLC
Entity Type:Organization
Organization Name:CEDAR PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:225-388-0518
Mailing Address - Street 1:125 N ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2511
Mailing Address - Country:US
Mailing Address - Phone:225-388-0518
Mailing Address - Fax:225-388-0517
Practice Address - Street 1:125 N ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2511
Practice Address - Country:US
Practice Address - Phone:225-388-0518
Practice Address - Fax:225-388-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health