Healthcare Provider Details

I. General information

NPI: 1548087356
Provider Name (Legal Business Name): CARDINAL 360 LOGISTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 ROANOKE RAPIDS RD
GASTON NC
27832
US

IV. Provider business mailing address

PO BOX 203
HENRICO NC
27842-0203
US

V. Phone/Fax

Practice location:
  • Phone: 252-578-8334
  • Fax: 804-655-6706
Mailing address:
  • Phone: 252-326-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL MASON-DICKENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-326-1383