Provider Demographics
NPI:1356588537
Name:CEDAR RIDGE SCHOOL DISTRICT
Entity type:Organization
Organization Name:CEDAR RIDGE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEA SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-201-2577
Mailing Address - Street 1:1502 NORTH HILL STREET NEWARK AR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:AR
Mailing Address - Zip Code:72562-9544
Mailing Address - Country:US
Mailing Address - Phone:870-201-2577
Mailing Address - Fax:
Practice Address - Street 1:1502 NORTH HILL STREET NEWARK AR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:AR
Practice Address - Zip Code:72562-9544
Practice Address - Country:US
Practice Address - Phone:870-201-2577
Practice Address - Fax:870-799-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WS0200X
AR3212251300000X
AROTR2079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155335742Medicaid
AR171536761Medicaid