Provider Demographics
NPI:1871083493
Name:CARDINAL ENERGY HOME CARE, LLC
Entity type:Organization
Organization Name:CARDINAL ENERGY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ESQUIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-463-0493
Mailing Address - Street 1:124 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4625
Mailing Address - Country:US
Mailing Address - Phone:307-463-0493
Mailing Address - Fax:307-463-0595
Practice Address - Street 1:124 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4625
Practice Address - Country:US
Practice Address - Phone:307-463-0493
Practice Address - Fax:307-463-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2017-000779169251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health