Healthcare Provider Details

I. General information

NPI: 1215482229
Provider Name (Legal Business Name): CARDINAL RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 JACKSON PIKE
GALLIPOLIS OH
45631-2600
US

IV. Provider business mailing address

1134 JACKSON PIKE
GALLIPOLIS OH
45631-2600
US

V. Phone/Fax

Practice location:
  • Phone: 740-441-7954
  • Fax:
Mailing address:
  • Phone: 740-441-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number981153-CS
License Number StateOH

VIII. Authorized Official

Name: LORI A ELLIS
Title or Position: CLINICAL DIRECTOR/SUPERVISOR
Credential:
Phone: 740-441-7954