Provider Demographics
NPI:1144346164
Name:CEDAR HILLS GROUP HOME, INC.
Entity type:Organization
Organization Name:CEDAR HILLS GROUP HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUELLEN
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-998-2506
Mailing Address - Street 1:HC 2 BOX 39
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63967-9402
Mailing Address - Country:US
Mailing Address - Phone:573-297-3719
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 39
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63967-9402
Practice Address - Country:US
Practice Address - Phone:573-297-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6362-0494320900000X, 385HR2060X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services