Provider Demographics
NPI:1477205276
Name:SUSAN ROSETTE DBA CARDINAL COMFORT CARE
Entity type:Organization
Organization Name:SUSAN ROSETTE DBA CARDINAL COMFORT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:NAR, CMT, TMA DSS
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558988220OtherNPI