Provider Demographics
NPI:1992102800
Name:CARDINALE HEALTHCARE HC1 INC
Entity type:Organization
Organization Name:CARDINALE HEALTHCARE HC1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-609-1112
Mailing Address - Street 1:6632 SUGA CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6455
Mailing Address - Country:US
Mailing Address - Phone:910-498-2434
Mailing Address - Fax:910-920-9074
Practice Address - Street 1:6632 SUGA CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6455
Practice Address - Country:US
Practice Address - Phone:888-609-1112
Practice Address - Fax:910-920-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4698251F00000X, 251J00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCMedicaid