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General NPI Number Information
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NPI Number | 1164283750
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Entity Type | Organization
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Legal Business Name | CARDINAL VIRTUES LONG TERM CARE
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 121 FAIRWAY AVE
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City | PIKETON
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State | OH
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Zip | 45661-9123
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Country | US
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Telephone | 740-352-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 121 FAIRWAY AVE
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City | PIKETON
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State | OH
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Zip | 45661-9123
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Country | US
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Telephone | 740-352-7733
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SEAN STILTNER
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Credential | DO
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Telephone | 740-352-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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