Basic Information
| Provider Information | |||||||||
| NPI: | 1760601801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDINAL CARE CENTER INC | ||||||||
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| OtherOrganizationName: | CARDINAL CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3073 HORSESHOE DR S | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341046144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399633400 | ||||||||
| FaxNumber: | 2399633401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286933388 | ||||||||
| FaxNumber: | 8286975461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | FORD | ||||||||
| AuthorizedOfficialFirstName: | DORENE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF M I S | ||||||||
| AuthorizedOfficialTelephone: | 2399633400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL045001 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 7802303 | 05 | NC | MEDICAID |