Provider Demographics
NPI:1104677582
Name:CEDARS HOME CARE LLC DBA CEDARS HOMECARE OF WA
Entity type:Organization
Organization Name:CEDARS HOME CARE LLC DBA CEDARS HOMECARE OF WA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-736-1998
Mailing Address - Street 1:1673 S MARKET BLVD # 108
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3826
Mailing Address - Country:US
Mailing Address - Phone:360-736-1998
Mailing Address - Fax:
Practice Address - Street 1:903 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1052
Practice Address - Country:US
Practice Address - Phone:360-736-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care