Organization
CEDAR CREST OF COSMOS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMON M EWALD (BUSINESS MANAGER)
(320) 587-7077
Entity
Organization
Contact information
Practice address
130 NEPTUNE ST N, COSMOS, MN 56228-9610
(320) 587-7077
(320) 587-4299
Mailing address
130 NEPTUNE ST N, COSMOS, MN 56228-9610
(320) 587-7077
(320) 587-4299
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FBL-171014162
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A161667600
—
MN
Enumeration date
04/08/2009
Last updated
04/08/2009
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