Organization
CEDAR CREST MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TARRI ALDRIDGE (BOARD MEMBER)
(580) 355-1616
Entity
Organization
Contact information
Practice address
1700 NW FORT SILL BLVD, LAWTON, OK 73507-4064
(580) 355-1616
(580) 355-2814
Mailing address
1700 NW FORT SILL BLVD, LAWTON, OK 73507-4064
(580) 355-1616
(580) 355-2814
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH1602-1602
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100773120A
—
OK
01
—
37E548
FEDERAL ID NUMBER
OK
Enumeration date
11/13/2006
Last updated
07/09/2010
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