=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417239831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARDOR HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2011
-----------------------------------------------------
Last Update Date | 09/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12302 CROWN HILL CT
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-7555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-693-6843
-----------------------------------------------------
Fax | 952-681-2647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12302 CROWN HILL CT
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-7555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-693-6843
-----------------------------------------------------
Fax | 952-681-2647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KUMBA KANU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-693-6843
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 352740
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------