Provider Demographics
NPI:1699072553
Name:425 CEDARCREST ROAD OPERATING COMPANY, LP
Entity type:Organization
Organization Name:425 CEDARCREST ROAD OPERATING COMPANY, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR REVENUE CYCLE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-361-6636
Mailing Address - Street 1:500 SENECA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1963
Mailing Address - Country:US
Mailing Address - Phone:716-361-6636
Mailing Address - Fax:
Practice Address - Street 1:425 CEDAR CREST DR
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1620
Practice Address - Country:US
Practice Address - Phone:215-804-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA136710251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA136710OtherPENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE