Provider Demographics
NPI:1518395284
Name:CADRE IDEAL LLC
Entity Type:Organization
Organization Name:CADRE IDEAL LLC
Other - Org Name:CADRE IDEAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYPRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-755-2225
Mailing Address - Street 1:60-70 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60-70 MILTON STREET
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:617-755-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization