Provider Demographics
NPI:1669460242
Name:SENIOR CARE CEDAR HILLS LLC
Entity Type:Organization
Organization Name:SENIOR CARE CEDAR HILLS LLC
Other - Org Name:CEDAR HILLS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND COO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-771-7575
Mailing Address - Street 1:2061 HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3815
Mailing Address - Country:US
Mailing Address - Phone:904-786-7331
Mailing Address - Fax:904-786-4034
Practice Address - Street 1:2061 HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3815
Practice Address - Country:US
Practice Address - Phone:904-786-7331
Practice Address - Fax:904-786-4034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCAT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-08
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF10800961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-5287Medicare PIN
FL4892330001Medicare NSC