Provider Demographics
NPI:1396422093
Name:CARDINAL COMFORT CARE COOPERATIVE
Entity type:Organization
Organization Name:CARDINAL COMFORT CARE COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-969-6183
Mailing Address - Street 1:713 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1219
Mailing Address - Country:US
Mailing Address - Phone:218-969-6183
Mailing Address - Fax:218-522-9506
Practice Address - Street 1:713 12TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1219
Practice Address - Country:US
Practice Address - Phone:218-969-6183
Practice Address - Fax:218-522-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care