Cedar Park SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

133153 Issued in TX

Legal business name

CEDAR PARK SNF LLC

Doing business as

The Isle at Cedar Ridge

Practice address

2200 S. Lakeline Blvd.
Cedar Park, TX 78613-4563

Phone

(512) 219-0200

Fax

(512) 219-0466

NPI assigned

Mar 16, 2011

Last updated

Aug 21, 2012By 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

Craig Spaulding

Title

Manager

Phone

(214) 370-6200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Isle at Cedar Ridge Doing business as

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1750680872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5307 E MOCKINGBIRD LN",
            "address_2": "SUITE 1010",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752065109",
            "telephone_number": "214-370-2600",
            "fax_number": "214-370-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 S. LAKELINE BLVD.",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786134563",
            "telephone_number": "512-219-0200",
            "fax_number": "512-219-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR PARK SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-16",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "SPAULDING",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-370-6200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "133153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001019567",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Isle at Cedar Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; 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.