Provider Demographics
NPI:1013658194
Name:CEDAR GREEN RECOVERY LLC
Entity Type:Organization
Organization Name:CEDAR GREEN RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FERENCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:630-334-2019
Mailing Address - Street 1:150 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-8539
Mailing Address - Country:US
Mailing Address - Phone:630-334-2019
Mailing Address - Fax:
Practice Address - Street 1:150 CEDAR LN
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-8539
Practice Address - Country:US
Practice Address - Phone:630-334-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility