Provider Demographics
NPI:1699312314
Name:CARDINAL SUPPORT LLC
Entity type:Organization
Organization Name:CARDINAL SUPPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NWAMAKA
Authorized Official - Middle Name:LARVINE
Authorized Official - Last Name:EMERUEM
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:972-503-4109
Mailing Address - Street 1:2804 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-8233
Mailing Address - Country:US
Mailing Address - Phone:972-503-4109
Mailing Address - Fax:
Practice Address - Street 1:2512 E EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4323
Practice Address - Country:US
Practice Address - Phone:972-503-4109
Practice Address - Fax:972-449-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-01
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center