Healthcare Provider Details

I. General information

NPI: 1205759867
Provider Name (Legal Business Name): BLUE CARDINAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 S SEELEY AVE
CHICAGO IL
60620-6035
US

IV. Provider business mailing address

8455 S SEELEY AVE
CHICAGO IL
60620-6035
US

V. Phone/Fax

Practice location:
  • Phone: 773-459-1465
  • Fax:
Mailing address:
  • Phone: 773-459-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CAMACHO
Title or Position: OWNER
Credential:
Phone: 773-459-1465