Cedar Lake Lodge, Inc.

LBN: Cedar Lake Lodge, Inc.
Cedar Lake Lodge, Inc. is an health care organization with primary practice located at 9505 Williamsburg Plz Ste 200 , Louisville KY 40222-5089. The organization recently has 5 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Intermediate Care Facility, Mental Illness, Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Respite Care Facility / Respite Care, Mental Retardation and/or Developmental Disabilities. Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded is the primary health care specialty. Cedar Lake Lodge, Inc. can be contacted via phone (502) 265-8389, or through Grimes, Courtney E via phone (025) 265-8389.

Contact Information

Primary practice address
9505 Williamsburg Plz Ste 200 Louisville KY 40222-5089
Phone: (502) 265-8389
Fax: (502) 425-3540
Website:
Map and Directions
Authorized official contact:
Name: Grimes, Courtney E CPB
Phone: (025) 265-8389

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mental Illness 310500000X 101120 Kentucky
Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility 313M00000X 101119 Kentucky
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 100450 Kentucky
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X
Respite Care Facility / Respite Care, Mental Retardation and/or Developmental Disabilities 385HR2060X

Profile Details

NPI number 1568508190
LBN Legal business name Cedar Lake Lodge, Inc.
DBA Doing business as
Authorized official Grimes, Courtney E CPB
Entity Organization
Organization subpart 1 No
Enumeration date Jan 30th, 2007
Last updated Dec 21st, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568508190 NPPES
Kentucky MEDICAID 43000512
Kentucky MEDICAID 11906153
Kentucky MEDICAID 33200353

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