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General NPI Number Information
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NPI Number | 1710805445
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Entity Type | Organization
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Legal Business Name | THE CARDINAL ASSISTED LIVING LLC
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 249 BRAYDEN DR
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City | ADVANCE
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State | NC
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Zip | 27006-8013
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Country | US
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Telephone | 704-682-7197
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Fax |
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Provider Business Mailing Address
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Address Line | 500 JOHNSON RIDGE RD
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City | ELKIN
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State | NC
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Zip | 28621-2420
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Country | US
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Telephone | 336-835-6672
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AKWIASDI REVELS
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Credential |
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Telephone | 704-682-7197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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