Provider Demographics
NPI:1831476605
Name:CEDAR RIVERSIDE COMMUNITY SCHOOL
Entity Type:Organization
Organization Name:CEDAR RIVERSIDE COMMUNITY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-339-5767
Mailing Address - Street 1:1610 S 6TH ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1102
Mailing Address - Country:US
Mailing Address - Phone:612-339-5767
Mailing Address - Fax:
Practice Address - Street 1:1610 S 6TH ST
Practice Address - Street 2:SUITE #100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1102
Practice Address - Country:US
Practice Address - Phone:612-339-5767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)