Organization
CEDAR RIDGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT NIELSON M.S., LMFT (PROGRAM DIRECTOR)
(435) 353-4498
Entity
Organization
Contact information
Practice address
RR 1 BOX 1477, ROOSEVELT, UT 84066-9735
(435) 353-4498
(435) 353-4898
Mailing address
RR 1 BOX 1477, ROOSEVELT, UT 84066-9735
(435) 353-4498
(435) 353-4898
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
15263
UT
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
15264
UT
Other
Enumeration date
01/27/2010
Last updated
01/27/2010
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