Cedar Lake Nursing Services, Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

1440 Issued in TX

Legal business name

CEDAR LAKE NURSING SERVICES, INC

Doing business as

CEDAR LAKE HOME HEALTH AND HOSPICE

Practice address

218 Park St
Trinidad, TX 75163-6060

Phone

(903) 489-2044

Fax

(903) 489-2044

NPI assigned

Mar 27, 2008

Organization subpart

No

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

Authorized official

Name

Cynthia Ann Calloway, RN

Title

Administrator

Phone

(903) 681-7406

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• CEDAR LAKE HOME HEALTH AND HOSPICE Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN 451565

Legal name

CEDAR LAKE NURSING SERVICES, INC

Doing business as

CEDAR LAKE HOME HEALTH AND HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 5, 1992

Last certification

Mar 4, 2021

Ownership / control type

Proprietary - Individual

Organization structure

CorporationProprietary

Incorporated

Sep 26, 1983 in TX

Enrollment address

218 Park St
Trinidad, TX 75163-6060

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Cedar Lake Nursing Services, Inc

  • Home Health Agency
  • Trinidad, TX
  • NPI 1851354039

  1355536657

  Same PAC ID

Listed as

Cedar Lake Home Health and HospiceCCN 451565

Ownership

For-Profit

Certified

Oct 5, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Cedar Lake Home Health and Hospice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cedar Lake Nursing Services, Inc

  • Home Health Agency
  • Trinidad, TX
  • NPI 1851354039
  NPD tax ID

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Ronald W Heine, M.D.

  • Family Medicine Physician
  • Athens, TX
  • NPI 1013912716

  Hospice

  Care Compare affiliation
• John D Updegrove, MD

  • Pulmonary Disease Physician
  • Corsicana, TX
  • NPI 1518933308

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782691200000",
    "number": "1770755902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2025",
            "city": "MALAKOFF",
            "state": "TX",
            "postal_code": "751482025",
            "telephone_number": "903-489-2043",
            "fax_number": "903-489-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 PARK ST",
            "city": "TRINIDAD",
            "state": "TX",
            "postal_code": "751636060",
            "telephone_number": "903-489-2044",
            "fax_number": "903-489-2044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "753 W 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Corsicana",
            "state": "TX",
            "postal_code": "751102942",
            "country_code": "US",
            "telephone_number": "903-874-4745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CEDAR LAKE NURSING SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A",
        "authorized_official_last_name": "CALLOWAY",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-681-7406",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "1440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "HH6837",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000205800",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "HH6962",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "HH6996",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "HH6838",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CEDAR LAKE HOME HEALTH AND HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CEDAR LAKE HOME HEALTH AND HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barbie Owen Bayless, PHYSICAL THERAPIST
• Tammi S Birch, RN BSN
• Cedar Lake Nursing Services, Inc
• Dlkpac PLLC
• John L Sawtelle DO PA
• Deborah A Kelley, PAC
• Gale Melvin Macziewski Jr., D.C.

• Community Based Hospice Care Agency in Trinidad, TX
• Providers in Trinidad, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.