| Cedar House Inc. | |
|
329 Faribault Rd Faribault MN 55021-5780 | |
| (507) 334-1983 | |
| (507) 333-2307 |
| Full Name | Cedar House Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 329 Faribault Rd, Faribault, Minnesota |
| Authorized Official Name and Position | Karen M Zeller (CEO) |
| Authorized Official Contact | 5073341983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar House Inc. 329 Faribault Rd P.o. Box 481 Faribault MN 55021-5780 Ph: (507) 334-1983 | Cedar House Inc. 329 Faribault Rd Faribault MN 55021-5780 Ph: (507) 334-1983 |
| NPI Number | 1952321424 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 11/06/2012 |
| Medicare PECOS PAC ID | 8729975479 |
|---|---|
| Medicare Enrollment ID | O20040228000100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952321424 | NPI | - | NPPES |
| 116910 | Other | MN | UCARE |
| 37437 | Other | MN | HEALTH PARTNERS |
| 13Q51CE | Other | MN | BHSI |
| 6580262-01 | Medicaid | MN | |
| 8446902 | Other | MN | MEDICA (UBH) |
| 1955551-00 | Medicaid | MN | |
| 6580262-00 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1955551-00 (Minnesota) | Primary |
| Provider Name | Tamara Domazet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811276819 PECOS PAC ID: 7315119195 Enrollment ID: I20111021000046 |
| Provider Name | Mary C Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659470409 PECOS PAC ID: 6709053762 Enrollment ID: I20120117000247 |
| Provider Name | Erin M Zeller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457726895 PECOS PAC ID: 9234382904 Enrollment ID: I20160128000764 |
| Provider Name | Alissa Marie Menke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518455096 PECOS PAC ID: 2567718109 Enrollment ID: I20180711003350 |
| Provider Name | Amy Jean Vasey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912593286 PECOS PAC ID: 3375957079 Enrollment ID: I20210120001920 |
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