Provider Demographics
NPI:1104262146
Name:CEDAR LIVING CENTER
Entity type:Organization
Organization Name:CEDAR LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-475-2208
Mailing Address - Street 1:810 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-2450
Mailing Address - Country:US
Mailing Address - Phone:785-475-2208
Mailing Address - Fax:785-475-2453
Practice Address - Street 1:810 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2450
Practice Address - Country:US
Practice Address - Phone:785-475-2208
Practice Address - Fax:785-475-2453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH020101313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility