Provider Demographics
NPI:1447835947
Name:CEDAR GROVE PRIVATE HOME CARE
Entity type:Organization
Organization Name:CEDAR GROVE PRIVATE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LANIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-743-6133
Mailing Address - Street 1:245 S WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30630-2622
Mailing Address - Country:US
Mailing Address - Phone:706-743-6133
Mailing Address - Fax:
Practice Address - Street 1:245 S WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:GA
Practice Address - Zip Code:30630-2622
Practice Address - Country:US
Practice Address - Phone:706-743-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child