Cedar Crest of Cosmos

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

FBL-171014162 Issued in MN

Legal business name

CEDAR CREST OF COSMOS

Practice address

130 Neptune St N
Cosmos, MN 56228-9610

Phone

(320) 587-7077

Fax

(320) 587-4299

NPI assigned

Apr 8, 2009

Organization subpart

No

Name

Damon M Ewald

Title

Business Manager

Phone

(320) 587-7077

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 8, 2009.

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239148800000",
    "number": "1306089248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 NEPTUNE ST N",
            "city": "COSMOS",
            "state": "MN",
            "postal_code": "562289610",
            "telephone_number": "320-587-7077",
            "fax_number": "320-587-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 NEPTUNE ST N",
            "city": "COSMOS",
            "state": "MN",
            "postal_code": "562289610",
            "telephone_number": "320-587-7077",
            "fax_number": "320-587-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREST OF COSMOS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-08",
        "last_updated": "2009-04-08",
        "status": "A",
        "authorized_official_last_name": "EWALD",
        "authorized_official_first_name": "DAMON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "320-587-7077"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "FBL-171014162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A161667600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawna Adams
• Nicole Marie Alexander
• Amy Marie Atkins, BCBA, LBA
• Halii Kay Beilke
• Michelle Carlson
• City of Cosmos
• Megan Degner
• Misty Eystad
• Christina Garcia
• Ana Guenther, BCBA

• All providers in Cosmos, MN
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.