Provider Demographics
NPI:1609376664
Name:VERITAS SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:VERITAS SENIOR LIVING, LLC
Other - Org Name:CEDAR CREEK
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-510-5544
Mailing Address - Street 1:6858 SWINNEA RD BLDG 1A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9493
Mailing Address - Country:US
Mailing Address - Phone:662-510-5544
Mailing Address - Fax:662-510-5471
Practice Address - Street 1:4279 JUDITH AVE
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8166
Practice Address - Country:US
Practice Address - Phone:321-454-7768
Practice Address - Fax:321-454-7714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERIAS SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10541310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility