Healthcare Provider Details

I. General information

NPI: 1124357587
Provider Name (Legal Business Name): CARDINAL SKILLED REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 LEE RD
SHAKER HTS OH
44120-5122
US

IV. Provider business mailing address

3535 LEE RD
SHAKER HTS OH
44120-5122
US

V. Phone/Fax

Practice location:
  • Phone: 440-888-4526
  • Fax: 440-888-9102
Mailing address:
  • Phone: 440-888-4526
  • Fax: 440-888-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JONN R FORTUNA
Title or Position: OWNER
Credential: D.C.
Phone: 440-888-4526