NPIMap

Organization Active NPI

Benevolent Corporation Cedar Community

  • Assisted Living Facility
  • West Bend, WI
National Provider Identifier
1851391304
Registry record updated Oct 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
REGISTRATION #1993 Issued in WI
Legal business name
BENEVOLENT CORPORATION CEDAR COMMUNITY
Practice address
5577 Home Dr
West Bend, WI 53095-7616
Phone
(262) 306-2145
Fax
(262) 306-2146
NPI assigned
Jul 27, 2005
Organization subpart
Yes
Parent organization
BENEVOLENT CORPORATION CEDAR COMMUNITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 12, 2017

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

Authorized official

Name
Mr. Chris Cherney
Title
Cfo
Phone
(262) 306-4212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X REGISTRATION #1993 WI Primary

Addresses

Primary practice location

5577 Home Dr
West Bend, WI 53095-7616

Mailing address

5577 Home Dr
West Bend, WI 53095-7616
Phone (262) 306-2145

Other names 1

  • Cedar Bay East Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080204000012 WI Part B Supplier - Clinic/Group Practice 0749268662 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Bend, WI

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Benevolent Corporation Cedar Community

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507766400000",
    "number": "1851391304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5577 HOME DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530957616",
            "telephone_number": "262-306-2145",
            "fax_number": "262-306-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5577 HOME DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530957616",
            "telephone_number": "262-306-2145",
            "fax_number": "262-306-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEVOLENT CORPORATION CEDAR COMMUNITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BENEVOLENT CORPORATION CEDAR COMMUNITY",
        "enumeration_date": "2005-07-27",
        "last_updated": "2017-10-12",
        "status": "A",
        "authorized_official_last_name": "CHERNEY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "262-306-4212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": "REGISTRATION #1993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Bay East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.