Organization
CEDAR LAKE RESIDENCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY E GRIMES (PROGRAM BILLING & REIMB SPVSR)
(502) 265-8389
Entity
Organization
Contact information
Practice address
9505 WILLIAMSBURG PLZ, SUITE 200, LOUISVILLE, KY 40222-5082
(502) 327-7706
(502) 425-3540
Mailing address
9505 WILLIAMSBURG PLZ, SUITE 200, LOUISVILLE, KY 40222-5082
(502) 327-7706
(502) 425-3540
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
100934
KY
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33900572
—
KY
Enumeration date
01/30/2007
Last updated
10/19/2020
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