Healthcare Provider Details

I. General information

NPI: 1710805445
Provider Name (Legal Business Name): THE CARDINAL ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 BRAYDEN DR
ADVANCE NC
27006-8013
US

IV. Provider business mailing address

500 JOHNSON RIDGE RD
ELKIN NC
28621-2420
US

V. Phone/Fax

Practice location:
  • Phone: 704-682-7197
  • Fax:
Mailing address:
  • Phone: 336-835-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AKWIASDI REVELS
Title or Position: OWNER
Credential:
Phone: 704-682-7197