Provider Demographics
NPI:1831247006
Name:CEDAR MOUNTAIN HOUSE LLC
Entity type:Organization
Organization Name:CEDAR MOUNTAIN HOUSE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TREFZGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-324-8898
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2568
Mailing Address - Country:US
Mailing Address - Phone:828-324-8898
Mailing Address - Fax:828-322-9587
Practice Address - Street 1:11 SHERWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-6558
Practice Address - Country:US
Practice Address - Phone:828-884-9510
Practice Address - Fax:828-884-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-088-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805679Medicaid