Provider Demographics
NPI:1447505151
Name:CEDAR RIDGE
Entity type:Organization
Organization Name:CEDAR RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-605-5934
Mailing Address - Street 1:1250 N AIR DEPOT BLVD
Mailing Address - Street 2:APT. 111
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3349
Mailing Address - Country:US
Mailing Address - Phone:405-921-7322
Mailing Address - Fax:
Practice Address - Street 1:6501 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73141-9118
Practice Address - Country:US
Practice Address - Phone:405-605-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK283Q00000X283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital