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NPI Code Detail

MEDICARE: CARDINAL CARE CENTER, P.L.L.C.

MEDICARE: CARDINAL CARE CENTER, P.L.L.C.
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
1251S00000XCommunity/Behavioral Health Agency811016814AR

General Provider Information

NPI Number : 1609126796
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDINAL CARE CENTER, P.L.L.C.
Provider Business Mailing Address
First Line : PO BOX 903
Second Line :
City : FARMINGTON
State : AR
Zip : 72730-0903
Country : US
Telephone Number : 479-267-6934
Fax Number : 479-267-6934
Provider Business Practice Location Address
First Line : 128 SOUTHWINDS RD
Second Line : SUITE 3
City : FARMINGTON
State : AR
Zip : 72730-8652
Country : US
Telephone Number : 479-267-6934
Fax Number : 479-267-6934
Authorized Official
Title or Position : OWNER/PSYCHOTHERAPIST
Name : MRS. SHERRI LYNN GANSZ
Credential : LCSW
Telephone Number : 479-267-6934
Provider Enumeration Date : 09/15/2012
Last Update Date : 09/15/2012

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Directions to “CARDINAL CARE CENTER, P.L.L.C. ” Practice Location

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