Provider Demographics
NPI:1194909341
Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Entity type:Organization
Organization Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-306-4212
Mailing Address - Street 1:5595 COUNTY ROAD Z
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9224
Mailing Address - Country:US
Mailing Address - Phone:262-306-2100
Mailing Address - Fax:262-306-2126
Practice Address - Street 1:113 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3654
Practice Address - Country:US
Practice Address - Phone:262-338-8377
Practice Address - Fax:262-338-9555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEVOLENT CORPORATION CEDAR COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-24
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility