Healthcare Provider Details

I. General information

NPI: 1356074553
Provider Name (Legal Business Name): ARDOR CARE OF CONCORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 COPPERFIELD BLVD NE
CONCORD NC
28025-2404
US

IV. Provider business mailing address

9010 GLENWATER DR STE 106
CHARLOTTE NC
28262-8593
US

V. Phone/Fax

Practice location:
  • Phone: 704-566-3487
  • Fax:
Mailing address:
  • Phone: 704-566-3487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: RENU PAL
Title or Position: MEMBER MANAGER
Credential:
Phone: 704-566-3487