Provider Demographics
NPI:1215260880
Name:CEDAR CREEK ASSISTED LIVING
Entity type:Organization
Organization Name:CEDAR CREEK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-259-9101
Mailing Address - Street 1:P.O. BOX 18067
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40261-0067
Mailing Address - Country:US
Mailing Address - Phone:502-259-9101
Mailing Address - Fax:502-259-9109
Practice Address - Street 1:156 WINSTON DRIVE
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-432-8243
Practice Address - Fax:606-433-9805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN HOMES & SERVICES OF KENTUCKY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20011109801310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20011109801OtherASSISTED LIVING COMMUNITY CERTIFICATION