Healthcare Provider Details

I. General information

NPI: 1588010300
Provider Name (Legal Business Name): CARDINAL AVON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32900 DETROIT RD
AVON OH
44011-2018
US

IV. Provider business mailing address

25000 COUNTRY CLUB BLVD STE 255
NORTH OLMSTED OH
44070-5337
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-6201
  • Fax: 440-937-5955
Mailing address:
  • Phone: 330-554-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1195N
License Number StateOH

VIII. Authorized Official

Name: DANIEL PARKER
Title or Position: PRESIDENT
Credential:
Phone: 330-554-6619