Healthcare Provider Details

I. General information

NPI: 1427590421
Provider Name (Legal Business Name): CARDEA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PAVILION AVENUE SUITE 101
PROVIDENCE RI
02905
US

IV. Provider business mailing address

84A NIPMUC TRL
NORTH PROVIDENCE RI
02904-3198
US

V. Phone/Fax

Practice location:
  • Phone: 401-400-2530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHNC02387
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHNC02387
License Number StateRI

VIII. Authorized Official

Name: JONATHAN ZINNO
Title or Position: MEMBER
Credential: CPA
Phone: 401-400-2530