Provider Demographics
NPI:1710173273
Name:CARDINAL CARE INC
Entity Type:Organization
Organization Name:CARDINAL CARE INC
Other - Org Name:BLUE RIDGE RETIREMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF MIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-963-3400
Mailing Address - Street 1:5692 STRAND CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-3389
Mailing Address - Country:US
Mailing Address - Phone:239-963-3400
Mailing Address - Fax:239-963-3401
Practice Address - Street 1:913 9TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3315
Practice Address - Country:US
Practice Address - Phone:828-693-0871
Practice Address - Fax:828-697-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL045008310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802511Medicaid