Provider Demographics
NPI:1699062802
Name:CAH ACQUISITION COMPANY 1 LLC
Entity type:Organization
Organization Name:CAH ACQUISITION COMPANY 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:TITUS
Authorized Official - Last Name:AVIGNONE
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:214-502-9624
Mailing Address - Street 1:7920 BELT LINE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8155
Mailing Address - Country:US
Mailing Address - Phone:214-502-9624
Mailing Address - Fax:252-797-3889
Practice Address - Street 1:9500 NC HIGHWAY 94 NORTH
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:NC
Practice Address - Zip Code:27928-8808
Practice Address - Country:US
Practice Address - Phone:252-797-3869
Practice Address - Fax:252-797-3889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HMC/CAH CONSOLIDATED INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-08
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0006261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343442A&CMedicaid
NC343442A&CMedicaid