Healthcare Provider Details

I. General information

NPI: 1861616625
Provider Name (Legal Business Name): CORDIAL CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 FIELDCREST RD
SISTER BAY WI
54234-9385
US

IV. Provider business mailing address

305 FIELDCREST RD
SISTER BAY WI
54234-9385
US

V. Phone/Fax

Practice location:
  • Phone: 920-854-7225
  • Fax: 920-854-9048
Mailing address:
  • Phone: 920-854-7225
  • Fax: 920-854-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateWI

VIII. Authorized Official

Name: MARTHA L COVENTRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 920-493-5356