=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710173273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDINAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 02/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 9TH AVE W
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28791-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-693-0871
-----------------------------------------------------
Fax | 828-697-5461
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5692 STRAND CT
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-3389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-963-3400
-----------------------------------------------------
Fax | 239-963-3401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR OF MIS
-----------------------------------------------------
Name | MRS. DORENE M FORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-963-3400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | HAL045008
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------