Provider Demographics
NPI:1730323312
Name:CEDAR CREEK
Entity Type:Organization
Organization Name:CEDAR CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-721-2905
Mailing Address - Street 1:895 CENTRAL AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1961
Mailing Address - Country:US
Mailing Address - Phone:513-721-2905
Mailing Address - Fax:513-721-0799
Practice Address - Street 1:5411 FOMORIN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9575
Practice Address - Country:US
Practice Address - Phone:513-724-3337
Practice Address - Fax:513-724-7505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPILEPSY FOUNDATION OF GREATER CINCINNATI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0850093Medicaid