Provider Demographics
NPI:1952321424
Name:CEDAR HOUSE INC.
Entity Type:Organization
Organization Name:CEDAR HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-334-1983
Mailing Address - Street 1:329 FARIBAULT RD
Mailing Address - Street 2:P.O. BOX 481
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5780
Mailing Address - Country:US
Mailing Address - Phone:507-334-1983
Mailing Address - Fax:507-333-2307
Practice Address - Street 1:329 FARIBAULT RD
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5780
Practice Address - Country:US
Practice Address - Phone:507-334-1983
Practice Address - Fax:507-333-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1955551-00261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116910OtherUCARE
MN37437OtherHEALTH PARTNERS
MN13Q51CEOtherBHSI
MN6580262-01Medicaid
MN8446902OtherMEDICA (UBH)
MN1955551-00Medicaid
MN6580262-00Medicaid
MN13Q51CEOtherBHSI