Basic Information
| Provider Information | |||||||||
| NPI: | 1609126796 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDINAL CARE CENTER, P.L.L.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 903 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727300903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792676934 | ||||||||
| FaxNumber: | 4792676934 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 SOUTHWINDS RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727308652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792676934 | ||||||||
| FaxNumber: | 4792676934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2012 | ||||||||
| LastUpdateDate: | 09/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | GANSZ | ||||||||
| AuthorizedOfficialFirstName: | SHERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PSYCHOTHERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4792676934 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 811016814 | AR | Y | Agencies | Community/Behavioral Health |
No ID Information.