| Organization Name: | CEDAR CREEK CORRECTIONS CENTER |
| NPI Number: | 1750672572 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOUIS MCDERMOTT (HEALTHCARE FINANCE MANAGER) |
| Mailing Address: | 12200 Bordeaux Road Littlerock |
| State: | WA US |
| Postal Code: | 985560037 |
| Phone Number: | 3603594100 |
| Fax Number: | 3606643586 |
| NPI Enumeration Date: | 04/27/2011 |
| NPI Last Update Date: | 04/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Prison Health |
| Taxonomy Definition: | |