CEDAR CREEK CORRECTIONS CENTER (NPI# 1750672572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750672572 |
| Entity Type | Organization |
| Organization Name | CEDAR CREEK CORRECTIONS CENTER |
| Practice Address |
12200 Bordeaux Road Littlerock WA 98556-0037 |
| Mailing Address |
Po Box 41107 Olympia WA 98504-1107 |
| Practice Telephone | 3603594100 |
| Practice Fax Number | 3606643586 |
| Mailing Telephone | 3607258298 |
| Mailing Fax Number | 3605861320 |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |
| Authorized Official Name | LOUIS MCDERMOTT (HEALTHCARE FINANCE MANAGER) |
| Authorized Official Telephone | 3607258301 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEPARTMENT OF CORRECTIONS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2400X |
Clinic/Center Specialization: Prison Health |
Ambulatory Health Care Facilities |
| Street Address |
12200 BORDEAUX ROAD |
| City | LITTLEROCK |
| State | WA |
| Zip Code | 98556-0037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255655387 | Lynn Ann Majors | Physician Assistant | 12200 Bordeaux Road, Cedar Creek Corrections Center, Littlerock, WA 98556-0037 | 2010-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689141103 | Virginia Mae Kennedy | Counselor | 12200 Bordeaux Rd, Little Rock, WA 98556 | 2018-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087573 | Laura Ann Lien Mitobe | Counselor | 11108 East Ave. V 8, Littlerock, CA 93543 | 2020-09-09 |
| 1265991210 | Rocio Bernadette Landa | Behavioral Analyst | 31180 96th St E, Littlerock, CA 93543-3624 | 2019-03-19 |
| 1467951996 | Kurt Anthony Muniz II | Counselor | 8730 E Avenue T4, Littlerock, CA 93543-2713 | 2018-02-10 |
| 1679086623 | Audrea Jeanne Pena Brown | Counselor | 37540 97th St E, Littlerock, CA 93543-1206 | 2017-11-13 |
| 1720508112 | Griselda Navarro-castillo | Behavior Technician | 11722 E Avenue R, Littlerock, CA 93543-4114 | 2017-06-27 |
| 1609301217 | Daniel Raymond Beadle | Chiropractor | 35227 82nd St E, Littlerock, CA 93543 | 2017-04-21 |
| 1982138491 | Sonia Madrigal | Nurse Practitioner | 10242 East Ave R-4, Littlerock, CA 93543 | 2017-04-12 |
| 1598296493 | Sunflower Place Rcfe | Assisted Living Facility | 10022 E Avenue Q14, Littlerock, CA 93543-4135 | 2017-03-22 |
| 1134577695 | Emily Margaret De Cosse | Behavior Technician | 36711 90th St E, Littlerock, CA 93543-1823 | 2016-05-25 |
| 1184030629 | Carroll Manor | Custodial Care Facility | 38161 90th St E, Littlerock, CA 93543-4012 | 2014-07-04 |
| Find all providers in LITTLEROCK | ||||
| Taxonomy Code | 261QP2400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Prison Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902197882 | Airway Heights Correction Center | Clinic/Center | 11919 W. Sprague Avenue, Airway Heights, WA 99001-1899 | 2011-04-26 |
| 1194016576 | Olympic Correction Center | Clinic/Center | 11235 Hoh Mainline Rd, Forks, WA 98331-9492 | 2011-04-20 |
| 1538450911 | Larch Corrections Center | Clinic/Center | 15314 Ne Dole Valley Rd, Yacolt, WA 98675-9521 | 2011-04-20 |
| 1861813834 | Wa State Department of Corrections Headquarters | Clinic/Center | 7345 Linderson Way Sw, Tumwater, WA 98501-6504 | 2013-12-18 |
| 1588955306 | Monroe Correctional Complex | Clinic/Center | 16550 177th Ave Se, Monroe, WA 98272 | 2011-04-27 |
| 1114218591 | Washington Corrections Center for Women | Clinic/Center | 9601 Bujacich Rd Nw, Gig Harbor, WA 98332-8300 | 2011-04-20 |
| 1902197387 | Clallam Bay Corrections Center | Clinic/Center | 1830 Eagle Crest Way, Clallam Bay, WA 98326-9724 | 2011-04-20 |
| 1629369095 | Coyote Ridge Corrections Center | Clinic/Center | 1301 N Ephrata Ave, Connell, WA 99326-9601 | 2011-04-20 |
| 1164713558 | Washington State Penitentiary | Clinic/Center | 1313 N 13th Ave, Walla Walla, WA 99362-8817 | 2011-04-20 |
| 1427349802 | Stafford Creek Corrections Center | Clinic/Center | 191 Constantine Way, Aberdeen, WA 98520-9504 | 2011-04-20 |
| Find all providers with the same taxonomy | ||||
| City | LITTLEROCK |
| Zip Code | 98556 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.