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CEDAR LAKE LODGE, INC.
NPI 1568508190
Intermediate Care Facility, Intellectual Disabilities in Louisville, KY

Active since January 30, 2007
9505 WILLIAMSBURG PLZ STE 200, LOUISVILLE, KY 40222(502) 265-8389(502) 425-3540 Get Directions Write a Review

NPPES record last updated: December 21, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Cedar Lake Lodge, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CEDAR LAKE LODGE, INC. (NPI 1568508190) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Louisville, Kentucky and active in the NPI registry since January 2007. The organization lists Courtney E Grimes, Program Billing & Reimb Supervisor, as its authorized official.

NPPES Registry Identity

NPI1568508190
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameCEDAR LAKE LODGE, INC.
Location Address9505 WILLIAMSBURG PLZ STE 200Louisville, KY 40222-5089
Mailing Address9505 Williamsburg Plz Ste 200Louisville, KY 40222-5089 · (502) 265-8389 · Fax (502) 425-3540
Phone(502) 265-8389
Fax(502) 425-3540
Organization SubpartNo
Authorized OfficialCourtney E GrimesProgram Billing & Reimb Supervisor · (025) 265-8389
Enumeration DateJanuary 30, 2007
Last NPPES UpdateDecember 21, 2020
NPPES CertifiedDecember 21, 2020
✔ NPI 1568508190 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in KY · 100450
Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

Also ListedIntermediate Care Facility, Mental IllnessTaxonomy 310500000X · License 101120 (KY)
Also ListedNursing Facility/Intermediate Care FacilityTaxonomy 313M00000X · License 101119 (KY)
Also ListedCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesTaxonomy 320900000X
Also ListedRespite Care · Respite Care, Intellectual and/or Developmental DisabilitiesTaxonomy 385HR2060X
9505 WILLIAMSBURG PLZ STE 200, Louisville, KY 40222
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Other Identifiers 3

Medicaid33200353KY
Medicaid11906153KY
Medicaid43000512KY

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cedar Lake Lodge, Inc.'s NPI number?

The NPI number for Cedar Lake Lodge, Inc. is 1568508190. It was assigned to this organization in the NPPES registry on January 30, 2007.

Where is Cedar Lake Lodge, Inc. located?

Cedar Lake Lodge, Inc. is located at 9505 Williamsburg Plz Ste 200, Louisville, KY 40222. The listed phone number is (502) 265-8389.

What is Cedar Lake Lodge, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Cedar Lake Lodge, Inc. was last updated on December 21, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.