Healthcare Provider Details

I. General information

NPI: 1851161236
Provider Name (Legal Business Name): CARDINAL TAKODA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 AFFINITY PL
MOUNT HEALTHY OH
45231-3566
US

IV. Provider business mailing address

7750 AFFINITY PL
MOUNT HEALTHY OH
45231-3566
US

V. Phone/Fax

Practice location:
  • Phone: 440-793-2245
  • Fax:
Mailing address:
  • Phone: 440-793-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JOE ALTIERI
Title or Position: PRESIDENT
Credential:
Phone: 330-936-7158