Provider Demographics
NPI:1831375336
Name:CEDARDALE HEALTH CARE CENTRE, INC.
Entity type:Organization
Organization Name:CEDARDALE HEALTH CARE CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-332-5375
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758
Mailing Address - Country:US
Mailing Address - Phone:970-332-5375
Mailing Address - Fax:970-332-4383
Practice Address - Street 1:720 CLAY STREET
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758
Practice Address - Country:US
Practice Address - Phone:970-332-5375
Practice Address - Fax:970-332-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652185Medicaid
CO04139630OtherMEDICAID RESPITE
CO05652185Medicaid