Organization
CEDAR LAKE NURSING SERVICES, INC
Active
Other names
CEDAR LAKE HOME HEALTH AND HOSPICE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA A CALLOWAY RN (ADMINISTRATOR)
(903) 489-2043
Entity
Organization
Contact information
Practice address
218 PARK ST, TRINIDAD, TX 75163-6060
(903) 489-2044
(903) 489-2044
Mailing address
104 S TERRY ST, MALAKOFF, TX 75148-9206
(903) 489-2043
(903) 489-2044
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1440
TX
251G00000X
Community Based Hospice Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00205800
—
TX
05
—
023676201
—
TX
01
—
303932
UNITED HEALTHCARE
TX
Enumeration date
04/10/2006
Last updated
12/06/2024
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