Provider Demographics
NPI:1750381018
Name:CEDARS NURSING CARE CENTER INC
Entity type:Organization
Organization Name:CEDARS NURSING CARE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:S.
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-772-5456
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112-0466
Mailing Address - Country:US
Mailing Address - Phone:207-772-5456
Mailing Address - Fax:
Practice Address - Street 1:630 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2704
Practice Address - Country:US
Practice Address - Phone:207-772-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36134314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101830000Medicaid
ME0895310001Medicare NSC
ME101830000Medicaid