Provider Demographics
NPI:1780678367
Name:CEDAR CARE CENTER, INC
Entity Type:Organization
Organization Name:CEDAR CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:DOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-975-5287
Mailing Address - Street 1:4630 PLAINFIELD AVENUE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-957-3975
Mailing Address - Fax:616-957-1556
Practice Address - Street 1:400 JEFFERY ST
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-9572
Practice Address - Country:US
Practice Address - Phone:616-696-0170
Practice Address - Fax:616-696-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI414360314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1786240Medicaid
MI23-5294Medicare ID - Type Unspecified