Active NPI
Cedar Lake Nursing Services, Inc
- Home Health Agency
- Trinidad, TX
National Provider Identifier
1851354039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 1440
- 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
- Apr 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Cynthia A Calloway, RN
- Title
- Administrator
- Phone
- (903) 489-2043
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1440 | TX | Primary |
| Community Based Hospice Care Agency | 251G00000X |
Addresses
Primary practice location
218 Park St
Trinidad, TX 75163-6060
Mailing address
218 Park St
Trinidad, TX 75163-6060
Phone (903) 489-2043
Other practice location 1
753 W 2nd Ave
Corsicana, TX 75110-2942
Phone (903) 874-4745
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 023676201 | Medicaid | TX | |
| 303932 | Other | TX | UNITED HEALTHCARE |
| 00205800 | Medicaid | TX |
Other names 1
- CEDAR LAKE HOME HEALTH AND HOSPICE
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120402000491 | TX | Part A Provider - Home Health Agency | 1355536657 | Practice locations: Corsicana, TX; Trinidad, TX |
Home health agency certification: CCN 457582
- Legal name
- CEDAR LAKE NURSING SERVICES, INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Dec 28, 1983
- Last certification
- Oct 17, 2018
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- 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).
-
- Community Based Hospice Care Agency
- Trinidad, TX
- NPI 1770755902
1355536657
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Cedar Lake Home Health and Hospice
- Overall star rating
- Ownership
- Proprietary
- Certified
- Dec 28, 1983
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- Cedar Lake Home Health and Hospice
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community Based Hospice Care Agency
- Trinidad, TX
- NPI 1770755902
Locations
753 W 2nd Ave
Corsicana, TX 75110
Phone (903) 874-3232
1805 W Main St
#7
Gun Barrel City, TX 75156
Phone (903) 887-3772
104 S Terry St
Malakoff, TX 75148
Ownership & related parties
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Cynthia Calloway | W-2 Managing Employee | Nov 24, 2017 | |
| Loretta Humble | 5% Or Greater Direct Ownership Interest | Apr 15, 2019 | 100% |
| Corporate Officer | Sep 26, 1983 | ||
| Corporate Director | Sep 26, 1983 |
Practitioners & affiliated clinicians
Affiliated clinicians 8
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Gun Barrel City, TX
- NPI 1821093824
Home health agency
-
- Internal Medicine Physician
- Gun Barrel City, TX
- NPI 1386662419
Home health agency
-
- Internal Medicine Physician
- Athens, TX
- NPI 1942237078
Home health agency
-
- Family Medicine Physician
- Gun Barrel City, TX
- NPI 1699758136
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1782777600000",
"number": "1851354039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 PARK ST",
"city": "TRINIDAD",
"state": "TX",
"postal_code": "751636060",
"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": "2006-04-10",
"last_updated": "2026-06-30",
"certification_date": "2026-06-30",
"status": "A",
"authorized_official_last_name": "CALLOWAY",
"authorized_official_first_name": "CYNTHIA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "903-489-2043",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "TX",
"license": "1440",
"primary": true
},
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "023676201",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "303932",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00205800",
"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"
}
]
}Other providers in Trinidad, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.