# CEDAR RIDGE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639400989
- **Authorized official:** MR. ROBERT NIELSON M.S., LMFT (PROGRAM DIRECTOR)
- **Authorized official phone:** (435) 353-4498

## Contact information

- **Practice address:** RR 1 BOX 1477, ROOSEVELT, UT 84066-9735
- **Practice address phone:** (435) 353-4498
- **Practice address fax:** (435) 353-4898
- **Mailing address:** RR 1 BOX 1477, ROOSEVELT, UT 84066-9735
- **Mailing address phone:** (435) 353-4498
- **Mailing address fax:** (435) 353-4898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 15263 | UT | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 15264 | UT | Yes |

## Other

- **Enumeration date:** 01/27/2010
- **Last updated:** 01/27/2010