Healthcare Provider Details

I. General information

NPI: 1609788165
Provider Name (Legal Business Name): CARDINAL INDEPENDENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N SARAH ST
SAINT LOUIS MO
63113-3132
US

IV. Provider business mailing address

1100 N SARAH ST
SAINT LOUIS MO
63113-3132
US

V. Phone/Fax

Practice location:
  • Phone: 314-533-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DORISE ROBINSON
Title or Position: MANAGER
Credential:
Phone: 314-533-0801