=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679269567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDINAL CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2023
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32200 45TH ST LOT 323
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53105-9328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-729-9399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32200 45TH ST LOT 323
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53105-9328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-729-9399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | JENNIFER LOIBL
-----------------------------------------------------
Credential | CBRF
-----------------------------------------------------
Telephone | 262-729-9399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------