Provider Demographics
NPI:1124561469
Name:CARDINAL HOME CARE LLC
Entity Type:Organization
Organization Name:CARDINAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-351-2648
Mailing Address - Street 1:18 CONVENT GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368
Mailing Address - Country:US
Mailing Address - Phone:901-351-2648
Mailing Address - Fax:
Practice Address - Street 1:18 CONVENT GARDEN CT
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:901-351-2648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health