Provider Demographics
NPI:1235522962
Name:CARDINAL COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:CARDINAL COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EURICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-421-1686
Mailing Address - Street 1:PO BOX 87108
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-8108
Mailing Address - Country:US
Mailing Address - Phone:225-421-1686
Mailing Address - Fax:225-349-7392
Practice Address - Street 1:13702 COURSEY BLVD. BLDG 6 STE A 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817
Practice Address - Country:US
Practice Address - Phone:225-421-1686
Practice Address - Fax:225-349-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care