MEDICARE: CAH ACQUISITION COMPANY 1 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	H0006	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124018494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAH ACQUISITION COMPANY 1 LLC

Provider Business Mailing Address
First Line	:	7920 BELT LINE RD STE 215
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8155
Country	:	US
Telephone Number	:	214-502-9624
Fax Number	:	252-793-7740

Provider Business Practice Location Address
First Line	:	958 US HIGHWAY 64 E
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962
Country	:	US
Telephone Number	:	252-793-4135
Fax Number	:	252-793-7740

Authorized Official
Title or Position	:	CEO
Name	:	MR. FRANK TITUS AVIGNONE IV
Credential	:
Telephone Number	:	214-502-9624

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/31/2020

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Directions to “CAH ACQUISITION COMPANY 1 LLC ” Practice Location

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