Healthcare Provider Details

I. General information

NPI: 1457391542
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 US HIGHWAY 64 E
PLYMOUTH NC
27962
US

IV. Provider business mailing address

7920 BELT LINE RD STE 215
DALLAS TX
75254-8155
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-4135
  • Fax: 252-793-7740
Mailing address:
  • Phone: 214-502-9624
  • Fax: 252-793-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TONDA DEANN GARRISON
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 580-303-0840