Provider Demographics
NPI:1982206405
Name:CANNON CARE SERVICES
Entity Type:Organization
Organization Name:CANNON CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMIERE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-309-7312
Mailing Address - Street 1:3100 MARTHA ST APT I
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-6729
Mailing Address - Country:US
Mailing Address - Phone:720-309-7312
Mailing Address - Fax:
Practice Address - Street 1:3100 MARTHA ST APT I
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6729
Practice Address - Country:US
Practice Address - Phone:720-309-7312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMIERE CANNON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health