Organization Name: | CARDINAL HOUSE INC |
NPI Number: | 1427236900 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY MICHAEL BLAKELY (EX DIR SE) |
Mailing Address: | 200 Douglas Street Anna |
State: | IL US |
Postal Code: | 62906 |
Phone Number: | 6188337756 |
Fax Number: | 6188337756 |
NPI Enumeration Date: | 02/06/2008 |
NPI Last Update Date: | 02/06/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 965010 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |