Provider Demographics
NPI:1730304619
Name:CEDAR VALLEY HOSPICE, INC.
Entity Type:Organization
Organization Name:CEDAR VALLEY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANDERSEE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:319-272-2002
Mailing Address - Street 1:PO BOX 2880
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2880
Mailing Address - Country:US
Mailing Address - Phone:319-272-2002
Mailing Address - Fax:319-272-2071
Practice Address - Street 1:900 TOWER PARK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9098
Practice Address - Country:US
Practice Address - Phone:319-272-2002
Practice Address - Fax:319-272-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1504251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615047Medicaid
IA61504OtherWELLMARK BC BS OF IOWA
IA0615047Medicaid