Healthcare Provider Details

I. General information

NPI: 1609113406
Provider Name (Legal Business Name): CARDINAL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7136 PRESTON HWY
LOUISVILLE KY
40219-2722
US

IV. Provider business mailing address

7136 PRESTON HWY
LOUISVILLE KY
40219-2722
US

V. Phone/Fax

Practice location:
  • Phone: 502-969-2279
  • Fax: 502-969-2161
Mailing address:
  • Phone: 502-969-2279
  • Fax: 502-969-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSH SALINAS
Title or Position: MANAGER
Credential:
Phone: 305-825-1997