CEDAR LAKE LODGE INC. NPI 1568508190

NPI Information

NPI: 1568508190
Provider Name: CEDAR LAKE LODGE, INC.
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
9505 WILLIAMSBURG PLZ STE 200
LOUISVILLE, KY
ZIP 40222
Phone: (502) 265-8389
Get Directions

CEDAR LAKE LODGE, INC. is an intermediate care facility mentally retarded in Louisville, KY. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. CEDAR LAKE LODGE, INC. NPI is 1568508190. The provider is registered as an organization entity type.

The provider's business location address is:

9505 WILLIAMSBURG PLZ STE 200
LOUISVILLE, KY
ZIP 40222-089
Phone: (502) 265-8389
Fax: (502) 425-3540

The provider's authorized official is Courtney E Grimes .
The authorized official title is Program Billing & Reimb Supervisor and has the following contact phone number (025) 265-8389.

The enumeration date for this NPI number is 1/30/2007 and was last updated on 12/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310500000X	Intermediate Care Facility, Mental Illness		101120	KENTUCKY	No
2	313M00000X	Nursing Facility/Intermediate Care Facility		101119	KENTUCKY	No
3	315P00000X	Intermediate Care Facility, Intellectual Disabilities		100450	KENTUCKY	Yes
4	315P00000X	Intermediate Care Facility, Intellectual Disabilities				No
5	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				No
6	385HR2060X	Respite Care	Respite Care, Intellectual and/or Developmental Disabilities			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	33200353	MEDICAID	KENTUCKY
2	11906153	MEDICAID	KENTUCKY
3	43000512	MEDICAID	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »