MEDICARE: CARDINAL TAKODA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1669242046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL TAKODA, INC.

Provider Business Mailing Address
First Line	:	2049 JOHN GRAY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1059
Country	:	US
Telephone Number	:	440-793-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2049 JOHN GRAY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1059
Country	:	US
Telephone Number	:	440-793-2245
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOE ALTIERI
Credential	:
Telephone Number	:	330-936-7158

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	01/05/2024

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