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Organization
CEDAR LAKE NURSING HOME, INC.
Active
Organization
CEDAR LAKE NURSING HOME, INC.
Active
Other names
Cedar Lake Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORETTA LOUISE HUMBLE (GENERAL PARTNER)
(903) 489-1702
Entity
Organization
Contact information
Practice address
1611 W ROYALL BLVD, MALAKOFF, TX 75148-6202
(903) 489-1702
(903) 489-1703
Mailing address
PO BOX 1088, MALAKOFF, TX 75148-1088
(903) 489-1702
(903) 489-1703
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
000436301
TX
314000000X
Skilled Nursing Facility
Primary
675898
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000436301
—
TX
Enumeration date
01/18/2007
Last updated
03/04/2015
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