Provider Demographics
NPI:1083092274
Name:CARDINAL CUSHING CENTERS, INC.
Entity Type:Organization
Organization Name:CARDINAL CUSHING CENTERS, INC.
Other - Org Name:LIFE OPPORTUNITIES UNLIMITED - SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SIGMUND
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KOZARYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-829-1215
Mailing Address - Street 1:405 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2343
Mailing Address - Country:US
Mailing Address - Phone:781-829-1215
Mailing Address - Fax:781-826-4421
Practice Address - Street 1:291 ROCKLAND ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2385
Practice Address - Country:US
Practice Address - Phone:781-829-1215
Practice Address - Fax:781-826-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MATN66483251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1699077404Medicaid
MA1861765307Medicaid
MA1093839896Medicaid
MA1750583902Medicaid