Provider Demographics
NPI:1588010300
Name:CARDINAL AVON, INC.
Entity Type:Organization
Organization Name:CARDINAL AVON, INC.
Other - Org Name:AVON PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-554-6619
Mailing Address - Street 1:25000 COUNTRY CLUB BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5337
Mailing Address - Country:US
Mailing Address - Phone:330-554-6619
Mailing Address - Fax:
Practice Address - Street 1:32900 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2018
Practice Address - Country:US
Practice Address - Phone:440-937-6201
Practice Address - Fax:440-937-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1195N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168919Medicaid
OH365155Medicare Oscar/Certification