Healthcare Provider Details

I. General information

NPI: 1699230789
Provider Name (Legal Business Name): CARDINAL ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 MCKNIGHT MILL RD
GREENSBORO NC
27405-3017
US

IV. Provider business mailing address

2507 MCKNIGHT MILL RD
GREENSBORO NC
27405-3017
US

V. Phone/Fax

Practice location:
  • Phone: 336-446-9217
  • Fax:
Mailing address:
  • Phone: 336-763-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: REGINA NEVELS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 336-430-6592