=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942501804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDINAL CASE MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2010
-----------------------------------------------------
Last Update Date | 11/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 WOODFIN PL SUITE 130
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-253-2351
-----------------------------------------------------
Fax | 828-253-2350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 CROSS ST SUITE 219
-----------------------------------------------------
City | SPRUCE PINE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28777-6158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-765-4668
-----------------------------------------------------
Fax | 828-765-4669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER MANAGER
-----------------------------------------------------
Name | MRS. KELLY MCKINNEY BARNETT
-----------------------------------------------------
Credential | BS, QP
-----------------------------------------------------
Telephone | 828-765-4668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------