Healthcare Provider Details

I. General information

NPI: 1497275796
Provider Name (Legal Business Name): ARDENT COMPANION HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 STAFFORD STREET SUITE 202
WORCESTER MA
01603
US

IV. Provider business mailing address

93 STAFFORD STREET 2ND FLOOR SUITE 202
WORCESTER MA
01603-1459
US

V. Phone/Fax

Practice location:
  • Phone: 508-762-9699
  • Fax: 508-762-9193
Mailing address:
  • Phone: 508-762-9699
  • Fax: 508-762-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SAMPSON OSAFO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 508-762-9699