MEDICARE: CARDINAL OVERHEAD, 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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1720363179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL OVERHEAD, LLC

Provider Business Mailing Address
First Line	:	3206 TURKEY HOLLOW CT
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-3878
Country	:	US
Telephone Number	:	361-960-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	3837 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2919
Country	:	US
Telephone Number	:	361-792-0144
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. RAJITHA SOLECKI
Credential	:
Telephone Number	:	361-960-8401

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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