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: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W 2ND ST UNIT A
WAVERLY OH
45690-9433
US

IV. Provider business mailing address

PO BOX 429
PIKETON OH
45661-0429
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: SEAN D STILTNER
Title or Position: OWNER
Credential:
Phone: 740-352-7733