Provider Demographics
NPI:1770755902
Name:CEDAR LAKE NURSING SERVICES, INC
Entity type:Organization
Organization Name:CEDAR LAKE NURSING SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-292-7467
Mailing Address - Street 1:P.O. BOX 2025
Mailing Address - Street 2:
Mailing Address - City:MALAKOFF
Mailing Address - State:TX
Mailing Address - Zip Code:75148
Mailing Address - Country:US
Mailing Address - Phone:903-489-2023
Mailing Address - Fax:903-489-2044
Practice Address - Street 1:218 PARK ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:TX
Practice Address - Zip Code:75163-6060
Practice Address - Country:US
Practice Address - Phone:903-489-2044
Practice Address - Fax:903-489-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1440251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH6837OtherBLUE CROSS AND BLUE SHIEL
TX000205800Medicaid
TXHH6962OtherBCBS OF TEXAS
TXHH6996OtherBCBS OF TEXAS
TXHH6838OtherBCBS OF TEXAS
TXHH6962OtherBCBS OF TEXAS