Provider Demographics
NPI:1770171308
Name:CARDINAL HEALTH CARE SOLUTION LLC
Entity type:Organization
Organization Name:CARDINAL HEALTH CARE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-476-3951
Mailing Address - Street 1:4905 FAITH CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-5340
Mailing Address - Country:US
Mailing Address - Phone:240-476-3951
Mailing Address - Fax:
Practice Address - Street 1:4905 FAITH CROSSING CT
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-5340
Practice Address - Country:US
Practice Address - Phone:240-476-3951
Practice Address - Fax:301-248-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRMedicaid