Provider Demographics
NPI:1871318592
Name:CARDINAL TAKODA, INC.
Entity type:Organization
Organization Name:CARDINAL TAKODA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF GOVERNMENT AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-793-2245
Mailing Address - Street 1:350 KOLB DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5357
Mailing Address - Country:US
Mailing Address - Phone:513-874-0423
Mailing Address - Fax:513-874-0598
Practice Address - Street 1:350 KOLB DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5357
Practice Address - Country:US
Practice Address - Phone:513-874-0423
Practice Address - Fax:513-874-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities