1013603299 NPI number — CARDINAL TREATMENT CENTERS PIKETON, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013603299 NPI number — CARDINAL TREATMENT CENTERS PIKETON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDINAL TREATMENT CENTERS PIKETON, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013603299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 LINWOOD PLZ STE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-398-5185
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2266 WAKEFIELD MOUND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKETON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45661-9660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-343-2772
Provider Business Practice Location Address Fax Number:
740-529-0553
Provider Enumeration Date:
04/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SHKLYAR
Authorized Official First Name:
BEATRICE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
201-398-5185

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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