Healthcare Provider Details

I. General information

NPI: 1164283750
Provider Name (Legal Business Name): CARDINAL VIRTUES LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FAIRWAY AVE
PIKETON OH
45661-9123
US

IV. Provider business mailing address

121 FAIRWAY AVE
PIKETON OH
45661-9123
US

V. Phone/Fax

Practice location:
  • Phone: 740-352-7733
  • Fax:
Mailing address:
  • Phone: 740-352-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN STILTNER
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 740-352-7733