Provider Demographics
NPI:1194112672
Name:CEDAR CREST HOSPITAL
Entity type:Organization
Organization Name:CEDAR CREST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC, ATR
Authorized Official - Phone:254-833-0781
Mailing Address - Street 1:3500 S IH 35
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-9426
Mailing Address - Country:US
Mailing Address - Phone:254-939-4074
Mailing Address - Fax:
Practice Address - Street 1:3500 S IH 35
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-9426
Practice Address - Country:US
Practice Address - Phone:254-939-4074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital