Cedar Lake Residences, Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

CEDAR LAKE RESIDENCES, INC.

Practice address

9505 Williamsburg PLZ
Suite 200
Louisville, KY 40222-5082

Phone

(502) 327-7706

Fax

(502) 425-3540

NPI assigned

Jan 30, 2007

Last updated

Oct 19, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Courtney E Grimes

Title

Program Billing & Reimb Spvsr

Phone

(502) 265-8389

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1447396049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 WILLIAMSBURG PLZ",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225082",
            "telephone_number": "502-327-7706",
            "fax_number": "502-425-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 WILLIAMSBURG PLZ",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225082",
            "telephone_number": "502-327-7706",
            "fax_number": "502-425-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR LAKE RESIDENCES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PROGRAM BILLING & REIMB SPVSR",
        "authorized_official_telephone_number": "502-265-8389"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "KY",
            "license": "100934",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33900572",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert A Cecil Jr., P.T.
• Cedar Lake Lodge, Inc.
• Cedar Lake Lodge/Sycamore Run
• Cedar Lake Rehabilitation Services
• Cedar Lake Residences, Inc.
• David Thomas Celello, D.M.D.
• Paul C Celestre, MD
• Daven Ceniza
• Center for Accessible Living
• Center for Advanced Cardiac Therapies PSC

• Developmentally Disabled Services Day Training Agency in Louisville, KY
• Providers in Louisville, KY by specialty
• Developmentally Disabled Services Day Training Agency in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.