Provider Demographics
NPI:1790855567
Name:CEDAR CREST VILLAGE INC
Entity Type:Organization
Organization Name:CEDAR CREST VILLAGE INC
Other - Org Name:CEDAR CREST VILLAGE, INC., HOME HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2390
Mailing Address - Street 1:1 CEDAR CREST VILLAGE DRIVE
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-2100
Mailing Address - Country:US
Mailing Address - Phone:973-831-3500
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:1 CEDAR CREST VILLAGE DRIVE
Practice Address - Street 2:ATTN: HOME HEALTH ADMINISTRATOR
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-2100
Practice Address - Country:US
Practice Address - Phone:973-831-3500
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24165251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ317092Medicare Oscar/Certification