Provider Demographics
NPI:1447340591
Name:CEDAR TREE MINISTRIES, INC
Entity type:Organization
Organization Name:CEDAR TREE MINISTRIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:FANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-846-5635
Mailing Address - Street 1:1565 MORGAN RD SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3135
Mailing Address - Country:US
Mailing Address - Phone:910-846-5635
Mailing Address - Fax:910-846-2311
Practice Address - Street 1:1571 MORGAN RD SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-3135
Practice Address - Country:US
Practice Address - Phone:910-846-2011
Practice Address - Fax:910-846-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-010-052322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603844Medicaid