Provider Demographics
NPI:1699078824
Name:CEDAR BREEZE MEDICAL CARE LLC
Entity type:Organization
Organization Name:CEDAR BREEZE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-369-6500
Mailing Address - Street 1:PO BOX 6207
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-6207
Mailing Address - Country:US
Mailing Address - Phone:615-369-6500
Mailing Address - Fax:
Practice Address - Street 1:12414 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-0896
Practice Address - Country:US
Practice Address - Phone:615-369-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6357516251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health