Healthcare Provider Details

I. General information

NPI: 1174362305
Provider Name (Legal Business Name): ARDENT SENIOR CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SUNNYSLOPE RD FL 2
HOLLISTER CA
95023-5784
US

IV. Provider business mailing address

201 MCCRAY ST STE 232A
HOLLISTER CA
95023-4111
US

V. Phone/Fax

Practice location:
  • Phone: 831-537-4508
  • Fax:
Mailing address:
  • Phone: 831-537-4508
  • Fax: 831-265-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ROSANA BALDONADO CASTRONUEVO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 831-537-4508