Healthcare Provider Details

I. General information

NPI: 1144902453
Provider Name (Legal Business Name): ARDENT HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MARIANNE PL
STAFFORD VA
22554-1621
US

IV. Provider business mailing address

202 MARIANNE PL
STAFFORD VA
22554-1621
US

V. Phone/Fax

Practice location:
  • Phone: 571-275-0132
  • Fax:
Mailing address:
  • Phone: 571-275-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KHADIJA MACAULLY
Title or Position: DIRECTOR/CEO
Credential: NP
Phone: 571-275-0132