Provider Demographics
NPI:1609126796
Name:CARDINAL CARE CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:CARDINAL CARE CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GANSZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-267-6934
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-0903
Mailing Address - Country:US
Mailing Address - Phone:479-267-6934
Mailing Address - Fax:479-267-6934
Practice Address - Street 1:128 SOUTHWINDS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8652
Practice Address - Country:US
Practice Address - Phone:479-267-6934
Practice Address - Fax:479-267-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR811016814251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health