Healthcare Provider Details

I. General information

NPI: 1477205276
Provider Name (Legal Business Name): SUSAN ROSETTE DBA CARDINAL COMFORT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 12TH AVE
TWO HARBORS MN
55616-1219
US

IV. Provider business mailing address

713 12TH AVE
TWO HARBORS MN
55616-1219
US

V. Phone/Fax

Practice location:
  • Phone: 218-969-6183
  • Fax:
Mailing address:
  • Phone: 218-969-6183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN MARIE ROSETTE
Title or Position: OWNER MANAGER
Credential: NAR, CMT, TMA DSS
Phone: 218-969-6183