Cardinal House INC

NPI #1427236900 in Anna, Illinois

Provider Information

NPI Number: 1427236900
Entity Type: Organization
Organization Name: Cardinal House INC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Feb 6, 2008
Last Updated: Feb 6, 2008

Practice Location

Address: 200 DOUGLAS STREET
City: Anna
State: Illinois
ZIP Code: 62906
Phone: (618) 833-7756

Authorized Official

Name: MR. GREGORY MICHAEL BLAKELY, PT QMRP
Title: EX DIR SE
Phone: (618) 833-7756

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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