Provider Demographics
NPI:1972054138
Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Entity Type:Organization
Organization Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Other - Org Name:COTTAGES AT CEDAR RUN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-306-4212
Mailing Address - Street 1:6090 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4401
Mailing Address - Country:US
Mailing Address - Phone:262-365-6600
Mailing Address - Fax:262-365-7909
Practice Address - Street 1:5595 COUNTY ROAD Z
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9224
Practice Address - Country:US
Practice Address - Phone:262-306-2100
Practice Address - Fax:262-306-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0015048310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility